Provider Demographics
NPI:1245750249
Name:HOOSLINE, GINA MARIE
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:HOOSLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38 ROVING RD SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-5173
Mailing Address - Country:US
Mailing Address - Phone:678-847-8906
Mailing Address - Fax:
Practice Address - Street 1:38 ROVING RD SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121
Practice Address - Country:US
Practice Address - Phone:678-847-8906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor