Provider Demographics
NPI:1104017086
Name:H. KYLE GAY MD PC
Entity Type:Organization
Organization Name:H. KYLE GAY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEYWOOD
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-489-4123
Mailing Address - Street 1:532 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MILLEN
Mailing Address - State:GA
Mailing Address - Zip Code:30442-1602
Mailing Address - Country:US
Mailing Address - Phone:912-489-4123
Mailing Address - Fax:912-764-4977
Practice Address - Street 1:532 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1602
Practice Address - Country:US
Practice Address - Phone:912-489-4123
Practice Address - Fax:912-764-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000630957CMedicaid
GAGRP3571Medicare PIN