Provider Demographics
NPI:1336572403
Name:GURIN, EDWARD (CPO)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:GURIN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10985 CHANDON WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7859
Mailing Address - Country:US
Mailing Address - Phone:770-552-2960
Mailing Address - Fax:770-552-2961
Practice Address - Street 1:10985 CHANDON WAY
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-7859
Practice Address - Country:US
Practice Address - Phone:770-552-2960
Practice Address - Fax:770-552-2961
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO02185222Z00000X
GA2224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist