Provider Demographics
NPI:1023772969
Name:GHANDOUR, GEORGINA A (HEALTH COACH)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:A
Last Name:GHANDOUR
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8504
Mailing Address - Country:US
Mailing Address - Phone:980-237-4766
Mailing Address - Fax:980-404-2274
Practice Address - Street 1:10440 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8504
Practice Address - Country:US
Practice Address - Phone:980-237-4766
Practice Address - Fax:980-404-2274
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56509171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach