MEDICARE: RICHARD E GAYLES MD

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	208VP0014X	Interventional Pain Medicine Physician	ME73164	FL
2	208VP0014X	Interventional Pain Medicine Physician	96608	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1074660	OTHER	FL	CAQH
2	41862	OTHER	FL	BCBS
3	1861400459	OTHER		NPI
4	6754544	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1861400459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E GAYLES MD

Provider Business Mailing Address
First Line	:	455 PHILIP BLVD STE 140
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8768
Country	:	US
Telephone Number	:	770-962-3642
Fax Number	:	770-962-3643

Provider Business Practice Location Address
First Line	:	526 BANKHEAD HWY STE 101
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-2463
Country	:	US
Telephone Number	:	770-962-3642
Fax Number	:	770-962-3643

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	12/29/2025

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Directions to “ RICHARD E GAYLES MD” Practice Location

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