Provider Demographics
NPI:1932516309
Name:BISHOP, CASSIE L (NP)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:L
Last Name:BISHOP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3504
Mailing Address - Country:US
Mailing Address - Phone:706-647-9638
Mailing Address - Fax:706-647-5321
Practice Address - Street 1:523 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3504
Practice Address - Country:US
Practice Address - Phone:706-647-9638
Practice Address - Fax:706-647-5321
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2439OtherMEDICARE GROUP
GA003161623AMedicaid
GA202I501562Medicare PIN