Provider Demographics
NPI:1083140198
Name:GADDIS, ADRIAN (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:GADDIS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 MILLS POND RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-9111
Mailing Address - Country:US
Mailing Address - Phone:662-312-9613
Mailing Address - Fax:
Practice Address - Street 1:1801 FAYETTEVILLE ST
Practice Address - Street 2:B103 WALKER COMPLEX
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3129
Practice Address - Country:US
Practice Address - Phone:919-530-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-25492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer