Provider Demographics
NPI:1629497235
Name:GUIDEWELL EMERGENCY MEDICINE DOCTORS, LLC
Entity Type:Organization
Organization Name:GUIDEWELL EMERGENCY MEDICINE DOCTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-242-1365
Mailing Address - Street 1:PO BOX 744658
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 N. ORLANDO AVENUE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:904-854-7911
Practice Address - Fax:904-854-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care