Healthcare Provider Details

I. General information

NPI: 1871507640
Provider Name (Legal Business Name): GAYTON HEALTH CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 TAYLORS MILL RD
FORT VALLEY GA
31030
US

IV. Provider business mailing address

216 CORDER RD
WARNER ROBINS GA
31088-3604
US

V. Phone/Fax

Practice location:
  • Phone: 478-825-8223
  • Fax: 478-825-8224
Mailing address:
  • Phone: 478-923-5872
  • Fax: 478-922-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateGA

VIII. Authorized Official

Name: PATTY JONES
Title or Position: CREDENTIALING REPR
Credential:
Phone: 478-929-6272