Provider Demographics
NPI:1366617920
Name:GATLING, GLORIA MOHAMMED
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:MOHAMMED
Last Name:GATLING
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 1:4633 KELLYS TRL
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2319
Mailing Address - Country:US
Mailing Address - Phone:336-721-2135
Mailing Address - Fax:
Practice Address - Street 1:4633 KELLYS TRL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2319
Practice Address - Country:US
Practice Address - Phone:336-721-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor