Provider Demographics
NPI:1174348460
Name:ANTONIAK, GAYLE E
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:E
Last Name:ANTONIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2335
Mailing Address - Country:US
Mailing Address - Phone:917-566-1206
Mailing Address - Fax:
Practice Address - Street 1:100 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2335
Practice Address - Country:US
Practice Address - Phone:917-566-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management