1124417100 NPI number — LINDSAY BROOKE GAINES AA

Table of content: LINDSAY BROOKE GAINES AA (NPI 1124417100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124417100 NPI number — LINDSAY BROOKE GAINES AA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAINES
Provider First Name:
LINDSAY
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OUTLER
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124417100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 PALMETTO BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31410-2651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-441-4125
Provider Business Mailing Address Fax Number:
912-350-7036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 WATERS AVE
Provider Second Line Business Practice Location Address:
MEMORIAL HEALTH ANESTHETISTS
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31404-6220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-350-8977
Provider Business Practice Location Address Fax Number:
912-350-7036
Provider Enumeration Date:
01/14/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367H00000X , with the licence number: 007371 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)