Healthcare Provider Details

I. General information

NPI: 1437664497
Provider Name (Legal Business Name): MS. GAIL MARIE GREGORIO ADJANASUKNART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CANTON RD NE STE 200
MARIETTA GA
30060-7242
US

IV. Provider business mailing address

750 ECHO ST NW APT 1635
ATLANTA GA
30318-6757
US

V. Phone/Fax

Practice location:
  • Phone: 404-260-5151
  • Fax:
Mailing address:
  • Phone: 404-697-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN212246
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN212246
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: