Provider Demographics
NPI:1548395957
Name:GAILE, EDWARD HARLEY SR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:HARLEY
Last Name:GAILE
Suffix:SR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1285 UPPER HEMBREE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1143
Mailing Address - Country:US
Mailing Address - Phone:770-343-8565
Mailing Address - Fax:770-343-8651
Practice Address - Street 1:1505 NORTHSIDE FORSYTH DR
Practice Address - Street 2:STE 3600
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-343-8565
Practice Address - Fax:770-781-3559
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2018-03-08
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Provider Licenses
StateLicense IDTaxonomies
GA641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001027AMedicaid
GA97BBDVNMedicare ID - Type UnspecifiedGA CARRIER PROVIDER NUMBE