Active NPI
Guillermo Gomez, NP
- Family Nurse Practitioner
- Forest Park, GA
National Provider Identifier
1972508752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN126015 NP
- Practice address
- 4146 Jonesboro Rd
Forest Park, GA 30297-1038 - Phone
- (404) 361-2469
- NPI assigned
- Jun 17, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN126015 NP | GA | Primary |
Addresses
Primary practice location
4146 Jonesboro Rd
Forest Park, GA 30297-1038
Mailing address
165 Victoria Dr
Ellenwood, GA 30294-2854
Phone (770) 598-2158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 810457223B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN126015 NP | GA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214438400000",
"number": "1972508752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 VICTORIA DR",
"city": "ELLENWOOD",
"state": "GA",
"postal_code": "302942854",
"telephone_number": "770-598-2158",
"fax_number": "404-361-2427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4146 JONESBORO RD",
"city": "FOREST PARK",
"state": "GA",
"postal_code": "302971038",
"telephone_number": "404-361-2469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "GUILLERMO",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-17",
"last_updated": "2008-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN126015 NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "810457223B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Park, GA
- Lula Varist Gholson, MA CHRISTIAN COUNSEL
- Tiffany Denise Giles
- Gold Coast Diagnostics, LLC
- Golden Heart Hospice Care, LLC
- Shawn Wells Goldman, OM, RM, WMA
- Philip Richard Good, RD, LD
- Grace & Beauty Hair Restoration and Treatment Center, LLC
- Pamela Green, NURSE
- Deidra Armita Greenfield-Burch
- Terrica Griffin, M.S., CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.