Healthcare Provider Details

I. General information

NPI: 1265554596
Provider Name (Legal Business Name): GAIL A. KLINE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 1ST ST
MACON GA
31201-2825
US

IV. Provider business mailing address

575 1ST ST
MACON GA
31201-2825
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-7566
  • Fax: 478-743-2804
Mailing address:
  • Phone: 478-742-7566
  • Fax: 478-743-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN110772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: