Healthcare Provider Details

I. General information

NPI: 1114259678
Provider Name (Legal Business Name): CATHERINE DORSEY LADSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 HOSPITAL DR SUITE 304
MACON GA
31217-3899
US

IV. Provider business mailing address

330 HOSPITAL DR SUITE 304
MACON GA
31217-3899
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-1010
  • Fax: 478-742-9666
Mailing address:
  • Phone: 478-742-1010
  • Fax: 478-742-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN192197
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: