Provider Demographics
NPI:1215094768
Name:GORMAN, REBECCA (SERVICE COORDINATOR)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 PEBBLE TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3228
Mailing Address - Country:US
Mailing Address - Phone:678-485-0012
Mailing Address - Fax:
Practice Address - Street 1:341 PEBBLE TRL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-3228
Practice Address - Country:US
Practice Address - Phone:678-485-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator