MEDICARE: ANGELA RENEE ADDISON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN-NP228718	GA

General Provider Information

NPI Number	:	1093677569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA RENEE ADDISON FNP-C

Provider Business Mailing Address
First Line	:	128 COVE LANDING DR
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-3883
Country	:	US
Telephone Number	:	229-421-1784
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 S BROAD ST
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-6114
Country	:	US
Telephone Number	:	229-584-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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