Provider Demographics
NPI:1295738151
Name:SOARES-WELCH, CACIA (MD)
Entity type:Individual
Prefix:
First Name:CACIA
Middle Name:
Last Name:SOARES-WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CACIA
Other - Middle Name:VALERIA
Other - Last Name:SOARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3862
Mailing Address - Country:US
Mailing Address - Phone:770-536-9864
Mailing Address - Fax:770-297-5013
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE 500
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3861
Practice Address - Country:US
Practice Address - Phone:770-536-9864
Practice Address - Fax:770-297-5013
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55704207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
H20490Medicare UPIN