Healthcare Provider Details

I. General information

NPI: 1265395651
Provider Name (Legal Business Name): NDEYE A GAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 WILLIS DR
STOCKBRIDGE GA
30281-7272
US

IV. Provider business mailing address

1142 PARAMOUNT DR
MCDONOUGH GA
30253-8797
US

V. Phone/Fax

Practice location:
  • Phone: 404-781-4905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP265596
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: