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General NPI Number Information
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NPI Number | 1376805267
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Entity Type | Individual
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Provider Name | KEREESE S GAYLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 2199 COLLEGE AVE NE
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City | ATLANTA
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State | GA
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Zip | 30317-1334
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Country | US
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Telephone | 404-369-1692
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Fax |
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Provider Business Mailing Address
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Address Line | 406 M NORTHSIDE DRIVE
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone | 229-241-0059
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Fax | 229-241-2088
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 74177
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License Number State | GA
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