Healthcare Provider Details

I. General information

NPI: 1386399855
Provider Name (Legal Business Name): GAGE HOLDINGS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MILL CREEK WAY
ATHENS GA
30605-0112
US

IV. Provider business mailing address

128 PEARL ST
WOODSTOCK GA
30188-5229
US

V. Phone/Fax

Practice location:
  • Phone: 304-677-8387
  • Fax:
Mailing address:
  • Phone: 304-677-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN GAGE
Title or Position: PRESIDENT
Credential: DC
Phone: 304-677-8387