Individual
GUILLERMO GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4146 JONESBORO RD, FOREST PARK, GA 30297-1038
(404) 361-2469
Mailing address
165 VICTORIA DR, ELLENWOOD, GA 30294-2854
(770) 598-2158
(404) 361-2427
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN126015 NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
810457223B
—
GA
Enumeration date
06/17/2005
Last updated
06/26/2008
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