MEDICARE: MS. GAIL MARIE GREGORIO ADJANASUKNART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN212246	GA
2	363LF0000X	Family Nurse Practitioner	RN212246	GA

General Provider Information

NPI Number	:	1437664497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL MARIE GREGORIO ADJANASUKNART

Provider Business Mailing Address
First Line	:	750 ECHO ST NW APT 1635
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-6757
Country	:	US
Telephone Number	:	404-697-5529
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 CANTON RD NE STE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7242
Country	:	US
Telephone Number	:	404-260-5151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	09/03/2024

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