Provider Demographics
NPI:1932073830
Name:GATZ, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GATZ
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 1:14805 BURRELL RD
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-8483
Mailing Address - Country:US
Mailing Address - Phone:844-641-6401
Mailing Address - Fax:844-641-6401
Practice Address - Street 1:4535B GAUTIER VANCLEAVE RD
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-4810
Practice Address - Country:US
Practice Address - Phone:844-641-6401
Practice Address - Fax:844-641-6401
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1466432471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography