Provider Demographics
NPI:1639174600
Name:DUGGAR, GINA DARLENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:DARLENE
Last Name:DUGGAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:WHITE
Other - Last Name:DUGGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:157 CLINIC AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4454
Practice Address - Country:US
Practice Address - Phone:770-333-2220
Practice Address - Fax:678-581-7180
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1639174600OtherNPI NUMBER
GA202I502975Medicare PIN
GA178242166EMedicaid