Provider Demographics
NPI:1629110473
Name:GAYLE, TONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:GAYLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 EL PRADO CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3822
Mailing Address - Country:US
Mailing Address - Phone:678-938-0159
Mailing Address - Fax:
Practice Address - Street 1:2084 HEADLAND DR
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER EAST POINT, LLC
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344
Practice Address - Country:US
Practice Address - Phone:404-965-5691
Practice Address - Fax:404-965-5707
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001076213EP1101X, 213ES0000X, 213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I480018Medicare PIN
GA253655981CMedicaid
GA253655981AMedicaid
GA48SCCWSMedicare PIN
GA253655981BMedicaid