Provider Demographics
NPI:1942388087
Name:KADIS, GERALD N (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:N
Last Name:KADIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6107
Practice Address - Country:US
Practice Address - Phone:229-226-8880
Practice Address - Fax:229-226-6342
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020448207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002340118AMedicaid
GAD29894Medicare UPIN
GA00182707AMedicare ID - Type Unspecified