Healthcare Provider Details

I. General information

NPI: 1780906602
Provider Name (Legal Business Name): CHRISTIE C WADDELL RRT,RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTIE A CARROLL RRT,RCP

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 ROOSEVELT HWY
WARM SPRINGS GA
31830
US

IV. Provider business mailing address

PO BOX 963
WARM SPRINGS GA
31830-0963
US

V. Phone/Fax

Practice location:
  • Phone: 706-457-1145
  • Fax:
Mailing address:
  • Phone: 706-457-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3190
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2279G0305X
TaxonomyGeriatric Care Registered Respiratory Therapist
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: