Provider Demographics
NPI:1588033195
Name:GADDY, MARIA S (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:S
Last Name:GADDY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:706-454-0159
Mailing Address - Fax:706-454-0101
Practice Address - Street 1:1000 COWLES CLINC WAY STE M-200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4541
Practice Address - Country:US
Practice Address - Phone:706-454-0159
Practice Address - Fax:706-454-0101
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076804363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2025I00529OtherMEDICARE PTAN
GA003168013EMedicaid
GA003168013FMedicaid