Healthcare Provider Details

I. General information

NPI: 1972579209
Provider Name (Legal Business Name): JOAN F CAUDILL CFNP, RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR NE
ATLANTA GA
30303-2613
US

IV. Provider business mailing address

3666 CHURCHWELL CT
TUCKER GA
30084-2407
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-7566
  • Fax:
Mailing address:
  • Phone: 770-939-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRH049269
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: