Provider Demographics
NPI:1538721048
Name:GOPAUL, KURT CARLTON (RPSGT,CCSH,RST, RCP)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:CARLTON
Last Name:GOPAUL
Suffix:
Gender:M
Credentials:RPSGT,CCSH,RST, RCP
Other - Prefix:MR
Other - First Name:KURT
Other - Middle Name:CARLTON
Other - Last Name:GOPAUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPSGT, RST, RCP
Mailing Address - Street 1:PO BOX 143327
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6530
Mailing Address - Country:US
Mailing Address - Phone:678-860-5431
Mailing Address - Fax:
Practice Address - Street 1:100 ETOWAH TRCE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-5902
Practice Address - Country:US
Practice Address - Phone:678-860-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010451227800000X
347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified