Provider Demographics
NPI:1053737692
Name:GAINES, DAVID GREGORY II
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:GAINES
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4571
Mailing Address - Country:US
Mailing Address - Phone:706-754-3113
Mailing Address - Fax:865-291-2849
Practice Address - Street 1:541 HISTORIC HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-0037
Practice Address - Country:US
Practice Address - Phone:706-754-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant