Provider Demographics
NPI:1275319857
Name:GARDUNO, BRIAN (MD STUDENT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GARDUNO
Suffix:
Gender:M
Credentials:MD STUDENT
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:GARDUNO GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD STUDENT
Mailing Address - Street 1:285 HEATHGATE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3050
Practice Address - Country:US
Practice Address - Phone:404-616-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program