Provider Demographics
NPI:1912340928
Name:BETTS, CASSANDRA (RN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAIN ST UNIT 1134
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-6110
Mailing Address - Country:US
Mailing Address - Phone:678-748-0517
Mailing Address - Fax:
Practice Address - Street 1:3580 ATLANTA AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1706
Practice Address - Country:US
Practice Address - Phone:404-768-3351
Practice Address - Fax:404-763-2002
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148536163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care