Provider Demographics
NPI:1134468101
Name:CORDLE, EMMA (NP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CORDLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RIVERBEND DR SW
Mailing Address - Street 2:STE 100
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6005
Mailing Address - Country:US
Mailing Address - Phone:706-291-0884
Mailing Address - Fax:706-378-8267
Practice Address - Street 1:15 RIVERBEND DR SW
Practice Address - Street 2:STE 100
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6005
Practice Address - Country:US
Practice Address - Phone:706-291-0884
Practice Address - Fax:706-378-8267
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid