Provider Demographics
NPI:1396552808
Name:BAKHTIARI, GWYNNE KNAP (BA, CPD, CCCE, CLD)
Entity type:Individual
Prefix:
First Name:GWYNNE
Middle Name:KNAP
Last Name:BAKHTIARI
Suffix:
Gender:F
Credentials:BA, CPD, CCCE, CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 ALTA DR APT 3303
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6690
Mailing Address - Country:US
Mailing Address - Phone:404-569-4268
Mailing Address - Fax:
Practice Address - Street 1:4335 ALTA DR APT 3303
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6690
Practice Address - Country:US
Practice Address - Phone:404-569-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula