Provider Demographics
NPI:1942766779
Name:SUDDARTH, CAITLIN JENKINS (NP-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:JENKINS
Last Name:SUDDARTH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MIMOSA DR FL 2
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6676
Mailing Address - Country:US
Mailing Address - Phone:229-551-0083
Mailing Address - Fax:229-227-9642
Practice Address - Street 1:116 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6605
Practice Address - Country:US
Practice Address - Phone:229-584-5570
Practice Address - Fax:229-551-8697
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN222465363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner