Active NPI
Kereese S Gayle, M.D.
- Pediatrics Physician
- Atlanta, GA
National Provider Identifier
1376805267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 74177
- Practice address
- 2199 College Ave NE
Atlanta, GA 30317-1334 - Phone
- (404) 369-1692
- NPI assigned
- Jun 15, 2012
- Last updated
- Mar 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 74177 | GA | Primary |
Addresses
Primary practice location
2199 College Ave NE
Atlanta, GA 30317-1334
Mailing address
406 M Northside Drive
Valdosta, GA 31602
Phone (229) 241-0059
Other practice location 1
406 M Northside Drive
Valdosta, GA 31602
Phone (229) 241-0059
Other names 1
- Kereese S Gayle-Farias
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74177 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Pediatric Clinic, LLC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/10369/brand/1/csg/1/fhir/r4
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatrics Physician
- Valdosta, GA
- NPI 1982858767
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679011200000",
"number": "1376805267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 M NORTHSIDE DRIVE",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "31602",
"telephone_number": "229-241-0059",
"fax_number": "229-241-2088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2199 COLLEGE AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303171334",
"telephone_number": "404-369-1692"
}
],
"practiceLocations": [
{
"address_1": "406 M Northside Drive",
"address_purpose": "LOCATION",
"city": "Valdosta",
"state": "GA",
"postal_code": "31602",
"country_code": "US",
"telephone_number": "229-241-0059",
"fax_number": "229-241-2088",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GAYLE",
"first_name": "KEREESE",
"middle_name": "S",
"name_prefix": "Mrs.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-15",
"last_updated": "2023-03-17",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "74177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KEREESE",
"last_name": "GAYLE-FARIAS",
"middle_name": "S",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.