Healthcare Provider Details

I. General information

NPI: 1720997471
Provider Name (Legal Business Name): MS. ADASHA REDDING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W 1ST AVE
CORDELE GA
31015-3709
US

IV. Provider business mailing address

414 W 1ST AVE
CORDELE GA
31015-3709
US

V. Phone/Fax

Practice location:
  • Phone: 478-219-0456
  • Fax:
Mailing address:
  • Phone: 478-219-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number99-1840793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: