Basic Information
| Provider Information | |||||||||
| NPI: | 1912340928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BETTS | ||||||||
| FirstName: | CASSANDRA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 MAIN ST UNIT 1134 | ||||||||
| Address2: | |||||||||
| City: | HIRAM | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301416110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787480517 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3580 ATLANTA AVE | ||||||||
| Address2: | |||||||||
| City: | HAPEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303541706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047683351 | ||||||||
| FaxNumber: | 4047632002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | RN148536 | GA | Y | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No ID Information.