Provider Demographics
NPI:1073884987
Name:GAMEL, MARY SUZANNE (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUZANNE
Last Name:GAMEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2258
Mailing Address - Country:US
Mailing Address - Phone:706-647-2641
Mailing Address - Fax:706-647-2680
Practice Address - Street 1:1512 HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286
Practice Address - Country:US
Practice Address - Phone:706-647-2641
Practice Address - Fax:706-647-2680
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139591NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily