Provider Demographics
NPI:1376505917
Name:GAUDET, JAMES J (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:GAUDET
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2328
Mailing Address - Country:US
Mailing Address - Phone:478-477-9480
Mailing Address - Fax:478-477-0842
Practice Address - Street 1:3336 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2328
Practice Address - Country:US
Practice Address - Phone:478-477-9480
Practice Address - Fax:478-477-0842
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22290Medicare UPIN
GA350021539Medicare ID - Type UnspecifiedRAILROAD MEDICARE