Gatewood Clinic and Medspa LLC

Primary specialty

Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X

Legal business name

GATEWOOD CLINIC AND MEDSPA LLC

Practice address

715 Village Square Dr
Stone Mountain, GA 30083-3379

Phone

(470) 823-3051

Fax

(678) 615-2314

NPI assigned

Feb 14, 2025

Last updated

May 7, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Michele Pierson

Title

Owner

Phone

(770) 685-0718

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Toiquita Yvette Brown, FNP-C

  • Family Nurse Practitioner
  • Snellville, GA
  • NPI 1891416376

  Multi-Specialty

  Medicare reassignment NPD
• Francette Dubuche Bernard, FAMILY NURSE PRACTIT

  • Family Nurse Practitioner
  • Monroe, GA
  • NPI 1588186811
  Medicare reassignment NPD
• Nicole Lashaye McKnight

  • Nurse Practitioner
  • Brookhaven, GA
  • NPI 1295438216
  Medicare reassignment NPD
• Harlan Luke South, MD

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1750438099

  GA

  Medicare reassignment NPD
• Jerry Ethridge

  • Registered Nurse
  • Lawrenceville, GA
  • NPI 1851259105
  NPD
• Jacinta L Moore, NP

  • Family Nurse Practitioner
  • Stockbridge, GA
  • NPI 1922894955
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1871398842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2989 WILSONE PL",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833379",
            "telephone_number": "770-685-0718",
            "fax_number": "678-615-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 VILLAGE SQUARE DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833379",
            "telephone_number": "470-823-3051",
            "fax_number": "678-615-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWOOD CLINIC AND MEDSPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-14",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "PIERSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-685-0718"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana L Gamble
• Gelila Gari
• Veronica Garrett
• Gastone Mountain SNF LLC (Rosemont At Stone Mountain)
• Kim L Gates, PT
• Brandy Gatlin
• Carmella Andrea Gayle
• Ronda F Gedward, EDD
• Genematrix Laboratory LLC
• Gentia Behavioral Health Systems Inc.

• Clinical Genetics (M.D.) Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Clinical Genetics (M.D.) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.