MEDICARE: MRS. KEREESE S GAYLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	74177	GA

General Provider Information

NPI Number	:	1376805267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEREESE S GAYLE M.D.

Provider Business Mailing Address
First Line	:	406 M NORTHSIDE DRIVE
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602
Country	:	US
Telephone Number	:	229-241-0059
Fax Number	:	229-241-2088

Provider Business Practice Location Address
First Line	:	2199 COLLEGE AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1334
Country	:	US
Telephone Number	:	404-369-1692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	03/17/2023

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