Basic Information
| Provider Information | |||||||||
| NPI: | 1518337708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZEIDMAN | ||||||||
| FirstName: | GINA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 WHITE SANDS WAY | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300247429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785387367 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 CLEARVIEW AVE STE 111 | ||||||||
| Address2: | |||||||||
| City: | DORAVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704513100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | RN199076 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 003172485C | 05 | GA | MEDICAID | 0003172485B | 05 | GA | MEDICAID | 1611898 | 01 | GA | WELLCARE | OTHER |