Provider Demographics
NPI:1376805267
Name:GAYLE, KEREESE S (MD)
Entity Type:Individual
Prefix:MRS
First Name:KEREESE
Middle Name:S
Last Name:GAYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEREESE
Other - Middle Name:S
Other - Last Name:GAYLE-FARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 M NORTHSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602
Mailing Address - Country:US
Mailing Address - Phone:229-241-0059
Mailing Address - Fax:229-241-2088
Practice Address - Street 1:2199 COLLEGE AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1334
Practice Address - Country:US
Practice Address - Phone:404-369-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics