Provider Demographics
NPI:1982463840
Name:MOULTRIE, GAIL ANNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANNETTE
Last Name:MOULTRIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W MAPLE ST STE 1206
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2536
Mailing Address - Country:US
Mailing Address - Phone:470-835-4871
Mailing Address - Fax:
Practice Address - Street 1:514 W MAPLE ST STE 1206
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2536
Practice Address - Country:US
Practice Address - Phone:470-835-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN058950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse