Provider Demographics
NPI:1053536177
Name:GAYLE, WEZYANN (MD)
Entity type:Individual
Prefix:
First Name:WEZYANN
Middle Name:
Last Name:GAYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 LOGANVILLE HWY
Mailing Address - Street 2:350
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-2144
Mailing Address - Country:US
Mailing Address - Phone:770-791-0167
Mailing Address - Fax:770-791-0169
Practice Address - Street 1:916 LOGANVILLE HWY
Practice Address - Street 2:350
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2144
Practice Address - Country:US
Practice Address - Phone:770-791-0167
Practice Address - Fax:770-791-0169
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA227750295AMedicaid
GA227750295BMedicaid
GA227750295CMedicaid
GA227750295CMedicaid