Basic Information
Provider Information
NPI: 1548884331
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GIERSBERG
FirstName: CASILDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3814 HEARTLEAF DR NW
Address2:  
City: ACWORTH
State: GA
PostalCode: 301017653
CountryCode: US
TelephoneNumber: 7703549696
FaxNumber:  
Practice Location
Address1: 1984 PEACHTREE RD NW STE 515
Address2:  
City: ATLANTA
State: GA
PostalCode: 303095219
CountryCode: US
TelephoneNumber: 4043511745
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/08/2020
LastUpdateDate: 09/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN220342GAN Nursing Service ProvidersRegistered Nurse 
367500000XRN220342GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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