Provider Demographics
NPI:1346920709
Name:GADBOIS, MAX (NP)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:GADBOIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:E
Other - Middle Name:MAX
Other - Last Name:GADBOIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3000 HASELEY CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5884
Mailing Address - Country:US
Mailing Address - Phone:505-412-2321
Mailing Address - Fax:
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6426
Practice Address - Country:US
Practice Address - Phone:505-412-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306769363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care