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General NPI Number Information
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NPI Number | 1154119915
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Entity Type | Individual
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Provider Name | NATHAN SHRADER
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Gender | Male
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 3170 MARTIN LUTHER KING JR PKWY S
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City | PHENIX CITY
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State | AL
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Zip | 36869-8405
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Country | US
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Telephone | 334-298-2405
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Fax | 334-742-2840
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Provider Business Mailing Address
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Address Line | 2506 LAMBERT DR
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City | OPELIKA
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State | AL
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Zip | 36801-7237
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Country | US
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Telephone | 334-742-2718
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Fax | 334-742-2840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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