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General NPI Number Information
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NPI Number | 1558959890
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Entity Type | Individual
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Provider Name | AARON CAUDELL
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Gender | Male
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 164 NURSING HOME CIR
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3117
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Country | US
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Telephone | 706-745-4948
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Fax |
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Provider Business Mailing Address
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Address Line | 102 STILL RD
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City | CLARKESVILLE
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State | GA
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Zip | 30523-2913
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Country | US
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Telephone | 706-969-0319
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA004522
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License Number State | GA
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