Healthcare Provider Details

I. General information

NPI: 1205762929
Provider Name (Legal Business Name): GARY RANDALL PRESSLEY JR. DNAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 S MAIN ST
MOULTRIE GA
31768-6925
US

IV. Provider business mailing address

3131 S MAIN ST
MOULTRIE GA
31768-6925
US

V. Phone/Fax

Practice location:
  • Phone: 229-985-3420
  • Fax: 229-891-2117
Mailing address:
  • Phone: 229-985-3420
  • Fax: 229-891-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN270260
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: