Healthcare Provider Details

I. General information

NPI: 1760478481
Provider Name (Legal Business Name): GAYLE E PEREIRA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 N SHALLOWFORD RD ATTEN: MARTHA CRAWFORD
DUNWOODY GA
30338-6445
US

IV. Provider business mailing address

4575 N SHALLOWFORD RD ATTEN: MARTHA CRAWFORD
DUNWOODY GA
30338-6445
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8311
  • Fax: 770-454-4065
Mailing address:
  • Phone: 770-454-4286
  • Fax: 770-454-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN061944
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: