Provider Demographics
NPI:1790973576
Name:GADDY, NORMA ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:ELLEN
Last Name:GADDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 JOE FRANK HARRIS PKWY SE STE 220
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2161
Mailing Address - Country:US
Mailing Address - Phone:770-607-8111
Mailing Address - Fax:
Practice Address - Street 1:970 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:SUITE 220
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2159
Practice Address - Country:US
Practice Address - Phone:770-607-8111
Practice Address - Fax:770-607-4111
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042248207Q00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00723445AMedicaid
GA08BBTRXMedicare PIN
GA00723445AMedicaid