Provider Demographics
NPI:1518337708
Name:ZEIDMAN, GINA (APRN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ZEIDMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 WHITE SANDS WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7429
Mailing Address - Country:US
Mailing Address - Phone:678-538-7367
Mailing Address - Fax:
Practice Address - Street 1:2000 CLEARVIEW AVE STE 111
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340
Practice Address - Country:US
Practice Address - Phone:770-451-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199076363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003172485CMedicaid
GA0003172485BMedicaid
GA1611898OtherWELLCARE