Provider Demographics
NPI:1912340175
Name:GADDIS, ELIZABETH WILLIAMS (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WILLIAMS
Last Name:GADDIS
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 LENTZ RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1596
Mailing Address - Country:US
Mailing Address - Phone:704-657-4266
Mailing Address - Fax:
Practice Address - Street 1:733 N OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4128
Practice Address - Country:US
Practice Address - Phone:704-657-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC67445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist