Provider Demographics
NPI:1639807860
Name:CANADY, RENITA
Entity Type:Individual
Prefix:MS
First Name:RENITA
Middle Name:
Last Name:CANADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 CENTER POINTE CIR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7309
Mailing Address - Country:US
Mailing Address - Phone:850-321-0319
Mailing Address - Fax:
Practice Address - Street 1:2438 CENTER POINTE CIR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7309
Practice Address - Country:US
Practice Address - Phone:404-448-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist