Provider Demographics
NPI:1225674054
Name:CAUDILL, GILLIAN CHANCE
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:CHANCE
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BUCKINGHAM TER
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1576
Mailing Address - Country:US
Mailing Address - Phone:706-206-4293
Mailing Address - Fax:
Practice Address - Street 1:315 BUCKINGHAM TER
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1576
Practice Address - Country:US
Practice Address - Phone:706-206-4293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst