Provider Demographics
NPI:1831488667
Name:GENTLE MEDICAL SYSTEM, LLC.
Entity Type:Organization
Organization Name:GENTLE MEDICAL SYSTEM, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAWOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-963-0034
Mailing Address - Street 1:134 HURRICANE SHOALS RD NE STE G
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4445
Mailing Address - Country:US
Mailing Address - Phone:770-963-0034
Mailing Address - Fax:404-935-9394
Practice Address - Street 1:134 HURRICANE SHOALS RD NE STE G
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4445
Practice Address - Country:US
Practice Address - Phone:770-963-0034
Practice Address - Fax:404-935-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19124728332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19124728OtherBUSINESS LICENSE