Provider Demographics
NPI:1689395618
Name:KIDD, CASANDRA M (DRPH)
Entity Type:Individual
Prefix:DR
First Name:CASANDRA
Middle Name:M
Last Name:KIDD
Suffix:
Gender:F
Credentials:DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 PEACHTREE RD NE STE 145-1207
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1085
Mailing Address - Country:US
Mailing Address - Phone:833-448-4636
Mailing Address - Fax:833-448-4636
Practice Address - Street 1:3343 PEACHTREE RD NE STE 145-1207
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1085
Practice Address - Country:US
Practice Address - Phone:404-791-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local