Provider Demographics
NPI:1851036685
Name:GAY, GAIGE DARRELL
Entity Type:Individual
Prefix:
First Name:GAIGE
Middle Name:DARRELL
Last Name:GAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-5438
Mailing Address - Country:US
Mailing Address - Phone:229-985-2282
Mailing Address - Fax:229-985-9142
Practice Address - Street 1:1027 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5438
Practice Address - Country:US
Practice Address - Phone:229-985-2282
Practice Address - Fax:229-985-9142
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist