Provider Demographics
NPI:1043243496
Name:GADDIS, AUDIE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDIE
Middle Name:D
Last Name:GADDIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2322 BLUE STONE HILLS DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5403
Mailing Address - Country:US
Mailing Address - Phone:540-437-4820
Mailing Address - Fax:540-437-4823
Practice Address - Street 1:2322 BLUE STONE HILL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3407
Practice Address - Country:US
Practice Address - Phone:540-437-4820
Practice Address - Fax:540-437-4823
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003002103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001472Medicare PIN