Provider Demographics
NPI:1205678406
Name:GILES, NORMAN RYDELLE
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:RYDELLE
Last Name:GILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SURREY CT
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-6109
Mailing Address - Country:US
Mailing Address - Phone:706-768-5600
Mailing Address - Fax:
Practice Address - Street 1:109 SURREY CT
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-6109
Practice Address - Country:US
Practice Address - Phone:706-768-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician