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General NPI Number Information
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NPI Number | 1821060781
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Entity Type | Individual
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Provider Name | MISTY DAWN CAUDELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 1498 JESSE JEWELL PKWY SE STE D
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City | GAINESVILLE
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State | GA
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Zip | 30501-3874
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Country | US
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Telephone | 770-535-7546
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Fax | 770-535-7591
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Provider Business Mailing Address
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Address Line | PO BOX 1456
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City | GAINESVILLE
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State | GA
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Zip | 30503-1456
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Country | US
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Telephone | 770-535-7546
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Fax | 770-535-7591
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD425726
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 15031
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 058402
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License Number State | GA
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