Provider Demographics
NPI:1457465031
Name:GAYNOR, DEBORAH A (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 LONG LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4073
Mailing Address - Country:US
Mailing Address - Phone:770-645-0206
Mailing Address - Fax:
Practice Address - Street 1:110 N CORNERS PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2077
Practice Address - Country:US
Practice Address - Phone:770-888-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN108005363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics