Provider Demographics
NPI:1720435514
Name:CHEWNING, GARY LEE (FNP-C, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:CHEWNING
Suffix:
Gender:M
Credentials:FNP-C, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7161 WRIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-4101
Mailing Address - Country:US
Mailing Address - Phone:678-616-6283
Mailing Address - Fax:
Practice Address - Street 1:655 JESSE JEWELL PKWY SE STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3854
Practice Address - Country:US
Practice Address - Phone:770-536-6300
Practice Address - Fax:770-536-6006
Is Sole Proprietor?:No
Enumeration Date:2016-05-21
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208793363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176626MMedicaid
GA003176626NMedicaid
GA003176626OMedicaid
GA08037293OtherAMERIGROUP