Provider Demographics
NPI:1639994957
Name:GATTIS, CARMELLA R
Entity type:Individual
Prefix:
First Name:CARMELLA
Middle Name:R
Last Name:GATTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 GEORGETOWN RD NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-2254
Mailing Address - Country:US
Mailing Address - Phone:330-445-6290
Mailing Address - Fax:
Practice Address - Street 1:2122 GEORGETOWN RD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-2254
Practice Address - Country:US
Practice Address - Phone:330-445-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker