Provider Demographics
NPI:1760241871
Name:LOCKETT, GABRIEL (MS)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:LOCKETT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WINDMEADOWS BLVD APT N128
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-0447
Mailing Address - Country:US
Mailing Address - Phone:615-225-7049
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST RM 239
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1099
Practice Address - Country:US
Practice Address - Phone:617-575-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program