Healthcare Provider Details

I. General information

NPI: 1841768850
Provider Name (Legal Business Name): CADY CROSCUTT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CADY CROSCUTT RD

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 822
TOCCOA GA
30577-1413
US

IV. Provider business mailing address

PO BOX 822
TOCCOA GA
30577-1413
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: