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NPI Code Detail

MEDICARE: CASEY SALCEDO

MEDICARE: CASEY SALCEDO
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
1363LF0000XFamily Nurse PractitionerRN184724GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4G17368BOTHERGAMEDICARE PROVIDER ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2RN184724OTHERGAPROFESSIONAL LICENSE
31699324707OTHERGANPI

General Provider Information

NPI Number : 1699324707
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY SALCEDO
Provider Business Mailing Address
First Line : 1061 DOWDY RD STE 204
Second Line :
City : ATHENS
State : GA
Zip : 30606-5700
Country : US
Telephone Number : 706-621-7575
Fax Number : 833-305-0340
Provider Business Practice Location Address
First Line : 132 FRANKLIN SPRINGS ST STE A
Second Line :
City : ROYSTON
State : GA
Zip : 30662-4134
Country : US
Telephone Number : 706-621-7575
Fax Number : 833-305-0340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2019
Last Update Date : 12/12/2024

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Directions to “ CASEY SALCEDO ” Practice Location

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