Provider Demographics
NPI:1558091827
Name:CAUDELL, SYDNEY ELISE (NP-C)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELISE
Last Name:CAUDELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NORTON RD
Mailing Address - Street 2:
Mailing Address - City:EASTANOLLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30538-3002
Mailing Address - Country:US
Mailing Address - Phone:706-244-2660
Mailing Address - Fax:
Practice Address - Street 1:115 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-8734
Practice Address - Country:US
Practice Address - Phone:706-282-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN283320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily