Provider Demographics
NPI:1144901711
Name:GAY, DESIREE DONA
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:DONA
Last Name:GAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NETHERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-5330
Mailing Address - Country:US
Mailing Address - Phone:478-494-4900
Mailing Address - Fax:
Practice Address - Street 1:124 NETHERFIELD DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-5330
Practice Address - Country:US
Practice Address - Phone:478-494-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant