Basic Information
Provider Information
NPI: 1801101621
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: APRIL
MiddleName: GADDY
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 302 ERIN WAY
Address2:  
City: WARNER ROBINS
State: GA
PostalCode: 310881509
CountryCode: US
TelephoneNumber: 2294255601
FaxNumber: 4789298095
Practice Location
Address1: 1707 WATSON BLVD
Address2:  
City: WARNER ROBINS
State: GA
PostalCode: 310933606
CountryCode: US
TelephoneNumber: 4789298030
FaxNumber: 4789298095
Other Information
ProviderEnumerationDate: 08/17/2010
LastUpdateDate: 08/17/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XRN167974GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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