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General NPI Number Information
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NPI Number | 1104017086
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Entity Type | Organization
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Legal Business Name | H. KYLE GAY MD PC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 532 COLLEGE AVE
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City | MILLEN
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State | GA
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Zip | 30442-1602
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Country | US
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Telephone | 912-489-4123
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Fax | 912-764-4977
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Provider Business Mailing Address
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Address Line | 532 COLLEGE AVE
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City | MILLEN
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State | GA
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Zip | 30442-1602
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Country | US
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Telephone | 912-489-4123
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Fax | 912-764-4977
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Authorized Official
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Title or Position | OWNER
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Name | HEYWOOD KYLE GAY
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Credential | MD
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Telephone | 912-489-4123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 038768
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License Number State | GA
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