Provider Demographics
NPI:1861961534
Name:GAMMAGE, CASANDRA SUE (NP)
Entity type:Individual
Prefix:MRS
First Name:CASANDRA
Middle Name:SUE
Last Name:GAMMAGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4599
Mailing Address - Country:US
Mailing Address - Phone:706-221-6005
Mailing Address - Fax:
Practice Address - Street 1:71 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4599
Practice Address - Country:US
Practice Address - Phone:706-221-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202261363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care