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General NPI Number Information
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NPI Number | 1245194109
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Entity Type | Individual
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Provider Name | CANDACE BUTTS RN
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 974 KLONDIKE CT SW STE 102
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City | CONYERS
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State | GA
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Zip | 30094-5185
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Country | US
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Telephone | 678-680-3380
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Fax |
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Provider Business Mailing Address
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Address Line | 974 KLONDIKE CT SW STE 102
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City | CONYERS
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State | GA
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Zip | 30094-5185
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Country | US
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Telephone | 678-680-3380
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Fax |
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 139305
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 139305
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 139305
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License Number State | GA
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