Provider Demographics
NPI:1336896901
Name:WELDON, GAIL LAUREN (MA, APC,)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LAUREN
Last Name:WELDON
Suffix:
Gender:F
Credentials:MA, APC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CANAL ST STE 506
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4049
Mailing Address - Country:US
Mailing Address - Phone:912-623-4320
Mailing Address - Fax:912-525-2300
Practice Address - Street 1:138 CANAL ST STE 506
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4049
Practice Address - Country:US
Practice Address - Phone:912-623-4320
Practice Address - Fax:912-525-2300
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty