MEDICARE: DR. MISTY DAWN CAUDELL M.D.

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	174400000X	Specialist	MD425726	PA
2	207N00000X	Dermatology Physician	15031	NV
3	207N00000X	Dermatology Physician	058402	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821060781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MISTY DAWN CAUDELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1456
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30503-1456
Country	:	US
Telephone Number	:	770-535-7546
Fax Number	:	770-535-7591

Provider Business Practice Location Address
First Line	:	1498 JESSE JEWELL PKWY SE STE D
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3874
Country	:	US
Telephone Number	:	770-535-7546
Fax Number	:	770-535-7591

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	01/02/2023

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