Provider Demographics
NPI:1407493984
Name:MCLEOD, GAYLA FISHER (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:FISHER
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-1564
Mailing Address - Country:US
Mailing Address - Phone:478-934-3423
Mailing Address - Fax:
Practice Address - Street 1:1100 2ND ST SE
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-1564
Practice Address - Country:US
Practice Address - Phone:478-934-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0692025062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer