Provider Demographics
NPI:1821462979
Name:GP WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:GP WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDERPAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-485-3458
Mailing Address - Street 1:4855 FLOYD RD SW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4855 FLOYD RD SW
Practice Address - Street 2:SUITE 104
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1323
Practice Address - Country:US
Practice Address - Phone:770-485-3458
Practice Address - Fax:770-575-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty