Individual provider Active NPI

Deborah A Gaynor, CPNP

  • Pediatric Nurse Practitioner
  • Cumming, GA
National Provider Identifier
1457465031
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN108005 Issued in GA
Practice address
110 N Corners Pkwy
Cumming, GA 30040-2077
Phone
(770) 888-2882
NPI assigned
Aug 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN108005 GA Primary

Addresses

Primary practice location

110 N Corners Pkwy
Cumming, GA 30040-2077

Mailing address

2696 Long Lake Dr NE
Roswell, GA 30075-4073
Phone (770) 645-0206

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041110001004 GA Practitioner - Nurse Practitioner 6800859810 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN108005GAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group CurrentSince Oct 25, 2015 Accepting new patients
Roswell Pediatric Center, P.C. Past Accepting new patients
Veritas Collaborative Atlanta, LLC Dba the Emily Program Past Accepting new patients
Veritas Collaborative Georgia, LLC Past Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1194

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457465031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2696 LONG LAKE DR NE",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300754073",
            "telephone_number": "770-645-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N CORNERS PKWY",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402077",
            "telephone_number": "770-888-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYNOR",
        "first_name": "DEBORAH",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN108005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.