Provider Demographics
NPI:1922662428
Name:GAULDEN, AMBER LYNN (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNN
Last Name:GAULDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2134 FAIRFAX AVE APT C16
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3655
Mailing Address - Country:US
Mailing Address - Phone:864-360-5520
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST STE 930
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2017
Practice Address - Country:US
Practice Address - Phone:313-966-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program