MEDICARE: AEREON CADE

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	171W00000X	Contractor	059340352	GA

General Provider Information

NPI Number	:	1528609682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AEREON CADE

Provider Business Mailing Address
First Line	:	2529 WOLF DEN LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8767
Country	:	US
Telephone Number	:	678-357-0644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 WOLF DEN LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8767
Country	:	US
Telephone Number	:	678-357-0644
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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Directions to “ AEREON CADE ” Practice Location

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