Caudell, Misty Dawn

Caudell, Misty Dawn is an individual health care provider with primary practice located at 1498 Jesse Jewell Pkwy Se Ste D , Gainesville GA 30501-3874. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Caudell, Misty Dawn can be contacted via phone (770) 535-7546.

Contact Information

Primary practice address
1498 Jesse Jewell Pkwy Se Ste D Gainesville GA 30501-3874
Phone: (770) 535-7546
Fax: (770) 535-7591
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD425726 Pennsylvania
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 15031 Nevada
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 058402 Georgia

Profile Details

NPI number 1821060781
LBN Legal business name Caudell, Misty Dawn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 2006
Last updated Jan 2nd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821060781 NPPES
Pennsylvania MEDICAID 101343342

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