Provider Demographics
NPI:1639515455
Name:MCCALL-GASTON, NATALIE YVONNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:YVONNE
Last Name:MCCALL-GASTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 NORTH BLAIRS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168
Mailing Address - Country:US
Mailing Address - Phone:404-793-3806
Mailing Address - Fax:770-502-6492
Practice Address - Street 1:1707 NORTH BLAIRS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168
Practice Address - Country:US
Practice Address - Phone:404-793-3806
Practice Address - Fax:770-502-6492
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPN139162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily