Healthcare Provider Details

I. General information

NPI: 1003724501
Provider Name (Legal Business Name): CYNTHIA ADDISON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3576 COVINGTON HWY STE 206E
DECATUR GA
30032-1800
US

IV. Provider business mailing address

3576 COVINGTON HWY STE 206E
DECATUR GA
30032-1800
US

V. Phone/Fax

Practice location:
  • Phone: 770-539-5612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN266695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: