Provider Demographics
NPI:1093888588
Name:GAITHER, MAIA ALEES (MD)
Entity type:Individual
Prefix:
First Name:MAIA
Middle Name:ALEES
Last Name:GAITHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAIA
Other - Middle Name:
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1240 UPPER HEMBREE RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:888-381-8556
Mailing Address - Fax:470-517-2995
Practice Address - Street 1:1240 UPPER HEMBREE RD.
Practice Address - Street 2:SUITE A
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:888-381-8556
Practice Address - Fax:470-517-2995
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68961208000000X, 207K00000X
CAA755022080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003158333BMedicaid