Provider Demographics
NPI:1013954684
Name:GORHAM, ZERAH KENYA (MD)
Entity Type:Individual
Prefix:
First Name:ZERAH
Middle Name:KENYA
Last Name:GORHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MEDICAL WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2195
Mailing Address - Country:US
Mailing Address - Phone:770-736-2440
Mailing Address - Fax:
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:EASTSIDE MEDICAL CENTER
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30278
Practice Address - Country:US
Practice Address - Phone:770-736-2376
Practice Address - Fax:770-736-2379
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034839208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000483106NMedicaid
GA000483106NMedicaid
GA93BBTVQMedicare ID - Type Unspecified