Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD001076 | GA |
Y | 222Z00000X | Podiatrist | POD001076 | GA |
N | 213EP1101X | Primary Podiatric Medicine | POD001076 | GA |
N | 2081S0010X | Sports Medicine | POD001076 | GA |
N | 213ES0000X | Sports Medicine | POD001076 | GA |
N | 213ES0103X | Foot & Ankle Surgery | POD001076 | GA |
N | 213ES0131X | Foot Surgery | POD001076 | GA |
NPI | 1629110473 |
---|---|
Provider Name | Dr. Tony Gayle |
First Address | Stone Mountain, GA 30083-3822 |
Second Address | East Point, GA 30344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 09/07/2018 |