Healthcare Provider Details

I. General information

NPI: 1548981913
Provider Name (Legal Business Name): CASSANDRA GUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 NORTH AVE STE 104
JONESBORO GA
30236-3292
US

IV. Provider business mailing address

186 NORTH AVE STE 104
JONESBORO GA
30236-3292
US

V. Phone/Fax

Practice location:
  • Phone: 205-809-2223
  • Fax:
Mailing address:
  • Phone: 205-809-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: