Provider Demographics
NPI:1780906602
Name:WADDELL, CHRISTIE C (RRT,RCP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:C
Last Name:WADDELL
Suffix:
Gender:F
Credentials:RRT,RCP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:A
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT,RCP
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830-0963
Mailing Address - Country:US
Mailing Address - Phone:706-457-1145
Mailing Address - Fax:
Practice Address - Street 1:5427 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830
Practice Address - Country:US
Practice Address - Phone:706-457-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3190227900000X
GA2279G0305X, 2279P1004X, 2279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279G0305XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeriatric Care
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics
No2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation