Provider Demographics
NPI:1417485491
Name:CADET, JEAN FRITZNEL (NP)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:FRITZNEL
Last Name:CADET
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 ATHENS HWY
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4843
Mailing Address - Country:US
Mailing Address - Phone:770-554-2999
Mailing Address - Fax:
Practice Address - Street 1:367 ATHENS HWY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2204
Practice Address - Country:US
Practice Address - Phone:770-554-2999
Practice Address - Fax:770-554-2999
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187257363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1417485491Medicaid