Provider Demographics
NPI:1699149971
Name:WYCHE, GAIL DENISE
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DENISE
Last Name:WYCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:DENISE
Other - Last Name:WYCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2344 STANDING PEACHTREE CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5845
Mailing Address - Country:US
Mailing Address - Phone:516-528-0605
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 7 SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:678-447-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA250105163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)