Healthcare Provider Details

I. General information

NPI: 1093219826
Provider Name (Legal Business Name): JAIME RUTH RYCROFT CADCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME SALTER RYCROFT CADCI

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 TIFT AVE N STE 202
TIFTON GA
31794-1885
US

IV. Provider business mailing address

2402 TIFT AVE N STE 202
TIFTON GA
31794-1885
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-7898
  • Fax: 229-386-5818
Mailing address:
  • Phone: 229-382-7898
  • Fax: 229-386-5818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number862
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: