Provider Demographics
NPI:1801634332
Name:GADDIS, DORA ANN
Entity type:Individual
Prefix:MS
First Name:DORA
Middle Name:ANN
Last Name:GADDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:407 BRAIRWOOD DRIVE
Mailing Address - Street 2:SUITE 207C
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206
Mailing Address - Country:US
Mailing Address - Phone:769-216-3334
Mailing Address - Fax:769-216-3334
Practice Address - Street 1:407 BRAIRWOOD DRIVE
Practice Address - Street 2:SUITE 207C
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206
Practice Address - Country:US
Practice Address - Phone:769-216-3334
Practice Address - Fax:769-216-3334
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)