Provider Demographics
NPI:1003002247
Name:GAITHER, KRYSTAL TEMPLES (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:TEMPLES
Last Name:GAITHER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:GAIL
Other - Last Name:TEMPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:736 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-5807
Mailing Address - Country:US
Mailing Address - Phone:229-686-0771
Mailing Address - Fax:
Practice Address - Street 1:736 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-5807
Practice Address - Country:US
Practice Address - Phone:229-686-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA577891570AMedicaid
GA577891570BMedicaid