Provider Demographics
NPI:1366602005
Name:ETIENNE, GATHLINE (MD)
Entity type:Individual
Prefix:
First Name:GATHLINE
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 NEWNAN CROSSING BLVD E STE G
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6601
Mailing Address - Country:US
Mailing Address - Phone:678-633-3500
Mailing Address - Fax:
Practice Address - Street 1:1741 NEWNAN CROSSING BLVD E STE G
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6601
Practice Address - Country:US
Practice Address - Phone:678-633-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107645207W00000X
IL0361738762084N0400X
GA0705512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology