Healthcare Provider Details

I. General information

NPI: 1154719698
Provider Name (Legal Business Name): CANDACE CHERIE MIZE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 NORTHSIDE DR BLDG D
MACON GA
31210-2500
US

IV. Provider business mailing address

111 DOCTOR CIR
COLUMBIA SC
29203-6502
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax: 478-987-7747
Mailing address:
  • Phone: 800-491-0909
  • Fax: 478-987-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN190811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: