Healthcare Provider Details

I. General information

NPI: 1033035571
Provider Name (Legal Business Name): CRISTY GADDY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3899
US

IV. Provider business mailing address

336 JETT ROBERTS RD
JEFFERSON GA
30549-2890
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-1563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025404
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: