MEDICARE: GAYLE E PEREIRA CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN061944	GA

General Provider Information

NPI Number	:	1760478481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE E PEREIRA CRNA

Provider Business Mailing Address
First Line	:	4575 N SHALLOWFORD RD
Second Line	:	ATTEN: MARTHA CRAWFORD
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6445
Country	:	US
Telephone Number	:	770-454-4286
Fax Number	:	770-454-4065

Provider Business Practice Location Address
First Line	:	4575 N SHALLOWFORD RD
Second Line	:	ATTEN: MARTHA CRAWFORD
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6445
Country	:	US
Telephone Number	:	404-778-8311
Fax Number	:	770-454-4065

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/03/2017

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Directions to “ GAYLE E PEREIRA CRNA” Practice Location

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