Provider Demographics
NPI:1851845960
Name:CADAVOS, KRISTIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:CADAVOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 WALTON WAY
Mailing Address - Street 2:STE A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2674
Mailing Address - Country:US
Mailing Address - Phone:706-941-8358
Mailing Address - Fax:
Practice Address - Street 1:1456 WALTON WAY
Practice Address - Street 2:STE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2674
Practice Address - Country:US
Practice Address - Phone:706-941-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical