Healthcare Provider Details

I. General information

NPI: 1093888588
Provider Name (Legal Business Name): MAIA ALEES GAITHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAIA WALTON MD

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 05/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 UPPER HEMBREE RD. SUITE A
ROSWELL GA
30076
US

IV. Provider business mailing address

1240 UPPER HEMBREE RD. SUITE A
ROSWELL GA
30076
US

V. Phone/Fax

Practice location:
  • Phone: 888-381-8556
  • Fax: 470-517-2995
Mailing address:
  • Phone: 888-381-8556
  • Fax: 470-517-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number68961
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number68961
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberA75502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: