Provider Demographics
NPI:1043010283
Name:GAUNTLETT, NIGEL
Entity type:Individual
Prefix:
First Name:NIGEL
Middle Name:
Last Name:GAUNTLETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 KEATON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2035
Mailing Address - Country:US
Mailing Address - Phone:470-352-0524
Mailing Address - Fax:
Practice Address - Street 1:288 HIGH WAY 314
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:470-352-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171000000XOther Service ProvidersMilitary Health Care Provider