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General NPI Number Information
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NPI Number | 1356825251
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Entity Type | Individual
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Provider Name | SANDRA ANN GADDIS LPN
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Gender | Female
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 625 N 5TH AVE
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City | CHATSWORTH
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State | GA
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Zip | 30705-2416
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Country | US
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Telephone | 706-270-5033
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 APPLEWOOD DR STE 1
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City | DALTON
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State | GA
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Zip | 30720-2699
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Country | US
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Telephone | 706-270-5033
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Fax | 706-270-5111
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN042000
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License Number State | GA
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