Provider Demographics
NPI:1467646463
Name:OUBRE, GISELLE (LMT)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:OUBRE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501076
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31150-1076
Mailing Address - Country:US
Mailing Address - Phone:678-485-0302
Mailing Address - Fax:
Practice Address - Street 1:5830 SANDY SPRINGS CIR NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4834
Practice Address - Country:US
Practice Address - Phone:678-485-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-02
Last Update Date:2007-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist