Basic Information
| Provider Information | |||||||||
| NPI: | 1760478481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREIRA | ||||||||
| FirstName: | GAYLE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4575 N SHALLOWFORD RD | ||||||||
| Address2: | ATTEN: MARTHA CRAWFORD | ||||||||
| City: | DUNWOODY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704544286 | ||||||||
| FaxNumber: | 7704544065 | ||||||||
| Practice Location | |||||||||
| Address1: | 4575 N SHALLOWFORD RD | ||||||||
| Address2: | ATTEN: MARTHA CRAWFORD | ||||||||
| City: | DUNWOODY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047788311 | ||||||||
| FaxNumber: | 7704544065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 03/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN061944 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.