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General NPI Number Information
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NPI Number | 1639285430
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Entity Type | Individual
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Provider Name | CRYSTAL D GAY PA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 1235 FRIENDSHIP RD STE 100
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City | BRASELTON
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State | GA
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Zip | 30517-5624
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Country | US
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Telephone | 770-536-4352
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Fax | 770-532-8165
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Provider Business Mailing Address
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Address Line | 2406 LIGHTHOUSE MANOR DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-7401
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Country | US
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Telephone | 770-536-4352
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Fax | 770-532-8165
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3248
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003248
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License Number State | GA
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