Provider Demographics
NPI:1275793689
Name:GAYNOR, AMY LEMOYNE (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEMOYNE
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1110
Mailing Address - Country:US
Mailing Address - Phone:770-422-8505
Mailing Address - Fax:
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1110
Practice Address - Country:US
Practice Address - Phone:770-422-8505
Practice Address - Fax:770-424-7449
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2017-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN144324363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology