Healthcare Provider Details

I. General information

NPI: 1144795543
Provider Name (Legal Business Name): ANGELA DARLENE GERRALD RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE GERRALD

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 MERCY BLVD
SAVANNAH GA
31419-1791
US

IV. Provider business mailing address

1319 LEEFIELD STATION RD
BROOKLET GA
30415-6084
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-4100
  • Fax:
Mailing address:
  • Phone: 912-481-9825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN223095
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN223095
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: