Healthcare Provider Details

I. General information

NPI: 1912340928
Provider Name (Legal Business Name): CASSANDRA BETTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 ATLANTA AVE
HAPEVILLE GA
30354-1706
US

IV. Provider business mailing address

225 MAIN ST UNIT 1134
HIRAM GA
30141-6110
US

V. Phone/Fax

Practice location:
  • Phone: 404-768-3351
  • Fax: 404-763-2002
Mailing address:
  • Phone: 678-748-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN148536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: