Basic Information
| Provider Information | |||||||||
| NPI: | 1881620532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAY | ||||||||
| FirstName: | JUDITH | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2490 RIVERSIDE DR | ||||||||
| Address2: | STE B | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312041787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786336633 | ||||||||
| FaxNumber: | 4786339384 | ||||||||
| Practice Location | |||||||||
| Address1: | 888 PINE ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786337600 | ||||||||
| FaxNumber: | 4786337354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 02/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN039869 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 000921808E | 05 | GA | MEDICAID | 000921808D | 05 | GA | MEDICAID | 000921808C | 05 | GA | MEDICAID |