Provider Demographics
NPI:1982257960
Name:GAITERS, KAHLIL ASHLEY (DO)
Entity Type:Individual
Prefix:
First Name:KAHLIL
Middle Name:ASHLEY
Last Name:GAITERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936952
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10945 GEORGE MASON CIR STE 105
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2233
Practice Address - Country:US
Practice Address - Phone:703-361-5116
Practice Address - Fax:571-364-8911
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116033462390200000X
VA0102207285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program