Provider Demographics
NPI:1063651719
Name:GAMEDICAL ASSOCIATES,INC
Entity Type:Organization
Organization Name:GAMEDICAL ASSOCIATES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMA, OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-380-8353
Mailing Address - Street 1:3945 LAWRENCEVILLE HWY NW # 29
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2817
Mailing Address - Country:US
Mailing Address - Phone:678-380-8353
Mailing Address - Fax:678-380-8388
Practice Address - Street 1:3945 LAWRENCEVILLE HWY NW # 29
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2817
Practice Address - Country:US
Practice Address - Phone:678-380-8353
Practice Address - Fax:678-380-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1077186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1077186OtherPHYSICIAN ASSISTANTS