Provider Demographics
NPI:1639758634
Name:O'NEAL, GWENDOLYN PATRICIA
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:PATRICIA
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 PATTERSON CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4568
Mailing Address - Country:US
Mailing Address - Phone:678-857-0651
Mailing Address - Fax:
Practice Address - Street 1:9444 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4735
Practice Address - Country:US
Practice Address - Phone:678-857-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14032804163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health