Provider Demographics
NPI:1740406867
Name:REDDING, JOAN C (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:C
Last Name:REDDING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2627
Mailing Address - Country:US
Mailing Address - Phone:770-449-4299
Mailing Address - Fax:
Practice Address - Street 1:2660 OSBORNE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-2832
Practice Address - Country:US
Practice Address - Phone:404-231-9363
Practice Address - Fax:404-231-9569
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN036743164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse