Provider Demographics
NPI:1114958824
Name:CADLE, HARRIET EYVONNE (CFNP)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:EYVONNE
Last Name:CADLE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 REINHARDT COLLEGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1700
Mailing Address - Country:US
Mailing Address - Phone:770-517-7844
Mailing Address - Fax:678-494-7196
Practice Address - Street 1:157 REINHARDT COLLEGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-1700
Practice Address - Country:US
Practice Address - Phone:770-517-7844
Practice Address - Fax:678-494-7196
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA149820363LF0000X
GARN149820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA935695492MMedicaid
GA935695492BMedicaid