Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT003117 | GA |
Y | 213ES0000X | Sports Medicine | AT003117 | GA |
NPI | 1356909188 |
---|---|
Provider Name | Danielle Marie Gunnin |
First Address | Monroe, GA 30655-8486 |
Second Address | Lawrenceville, GA 30046-7694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2019 |
Last Update Date | 05/06/2019 |