Provider Demographics
NPI:1659535326
Name:GATLING DOMESTIC AGENCY
Entity Type:Organization
Organization Name:GATLING DOMESTIC AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:GATLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-721-2135
Mailing Address - Street 1:4633 KELLYS TRL
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2319
Mailing Address - Country:US
Mailing Address - Phone:336-721-2135
Mailing Address - Fax:
Practice Address - Street 1:4633 KELLYS TRL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2319
Practice Address - Country:US
Practice Address - Phone:336-721-2135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty