Basic Information
| Provider Information | |||||||||
| NPI: | 1972269272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GADDY | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | CHRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 DUNWOODY DR | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306053416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706014654 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1435 OGLETHORPE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065497755 | ||||||||
| FaxNumber: | 7063532309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2021 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW007795 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.