Provider Demographics
NPI:1609492693
Name:GATEWAY MEDSPA LLC DBA DANA
Entity Type:Organization
Organization Name:GATEWAY MEDSPA LLC DBA DANA
Other - Org Name:DANA INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOKELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-854-0146
Mailing Address - Street 1:165 CEDRIC ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5027
Mailing Address - Country:US
Mailing Address - Phone:229-405-1900
Mailing Address - Fax:229-304-4486
Practice Address - Street 1:165 CEDRIC ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5027
Practice Address - Country:US
Practice Address - Phone:229-405-1900
Practice Address - Fax:229-304-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty