Provider Demographics
NPI:1548378433
Name:AXAM, GAILYA L (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:GAILYA
Middle Name:L
Last Name:AXAM
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:175 TRINITY AVE SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3618
Mailing Address - Country:US
Mailing Address - Phone:404-577-9020
Mailing Address - Fax:404-577-8086
Practice Address - Street 1:175 TRINITY AVE SW
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3618
Practice Address - Country:US
Practice Address - Phone:404-577-9020
Practice Address - Fax:404-577-8086
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0093271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice