Provider Demographics
NPI:1437664497
Name:ADJANASUKNART, GAIL MARIE GREGORIO
Entity type:Individual
Prefix:MS
First Name:GAIL MARIE
Middle Name:GREGORIO
Last Name:ADJANASUKNART
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 1:750 ECHO ST NW APT 1635
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6757
Mailing Address - Country:US
Mailing Address - Phone:404-697-5529
Mailing Address - Fax:
Practice Address - Street 1:780 CANTON RD NE STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7242
Practice Address - Country:US
Practice Address - Phone:404-260-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212246163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse