Provider Demographics
NPI:1487710158
Name:MAYSHARK, GAIL (PHD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:MAYSHARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 OVER LAKE DR SE
Mailing Address - Street 2:ST.C
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1777
Mailing Address - Country:US
Mailing Address - Phone:770-922-6921
Mailing Address - Fax:770-934-2105
Practice Address - Street 1:1807 OVER LAKE DR SE
Practice Address - Street 2:ST.C
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1777
Practice Address - Country:US
Practice Address - Phone:770-922-6921
Practice Address - Fax:770-934-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA688BBCHGMedicare ID - Type Unspecified