CANDACE VANDIVER (NPI# 1720451222) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720451222 |
| Entity Type | Individual |
| Full Name | CANDACE VANDIVER |
| Practice Address |
11 Charlie Morris Rd Colbert GA 30628-2445 |
| Mailing Address |
Po Box 459 Colbert GA 30628-0459 |
| Practice Telephone | 7067882127 |
| Practice Fax Number | 7067882815 |
| Mailing Telephone | 7067882127 |
| Mailing Fax Number | 7067882815 |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2016-08-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN197822 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11 CHARLIE MORRIS RD |
| City | COLBERT |
| State | GA |
| Zip Code | 30628-2445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588642771 | Nicole Ford | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2006-01-06 |
| 1477176600 | Dallas Louis | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2020-05-21 |
| 1144849233 | Sarah Sammons | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2020-04-09 |
| 1174184030 | Evan Grovenstein | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2019-06-21 |
| 1245732254 | Medlink Georgia Inc | Pharmacy | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2018-03-06 |
| 1801248182 | Jordan Hoffman | Social Worker | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2016-07-11 |
| 1295172773 | Matthew Davis | Family Medicine | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2013-05-24 |
| 1336492503 | Nora Ann Blankenship | Social Worker | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2012-10-24 |
| 1972897700 | Akilah S Tomingas | Pediatrics | 11 Charlie Morris Rd, Colbert, GA 30628 | 2011-06-09 |
| 1851680938 | Kelly Pascual Montgomery | Pediatrics | 11 Charlie Morris Rd, Colbert, GA 30628 | 2011-03-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326173956 | Jonathan Marc Perry | Pharmacist | 15 Colbert Business Parkway, Fred's Pharmacy #1394, Colbert, GA 30628 | 2007-02-22 |
| 1366938086 | Preston Gantt, Md, Sa-c | Surgery | 191 Valley Rd, Colbert, GA 30628 | 2018-07-05 |
| 1902304538 | Preston Gantt | Surgery | 191 Valley Rd, Colbert, GA 30628 | 2018-01-29 |
| 1134559958 | Manuel Garcia-gaona | Physical Therapist | 19 Dogwood Dr, Colbert, GA 30628-1512 | 2013-11-14 |
| 1720353675 | Innovative Medical Group | Durable Medical Equipment & Medical Supplies | 232 Jeremy Dr, Colbert, GA 30628-1543 | 2012-03-11 |
| 1154399152 | Amanda Griffin Wagner | Psychologist | 11 Charlie Morris Rd Bldg 2, Colbert, GA 30628-2445 | 2006-03-08 |
| 1669951414 | Medlink Georgia Inc | Clinic/Center | 11 Charlie Morris Rd Bldg 2, Colbert, GA 30628-2445 | 2018-08-13 |
| 1033449665 | Freds Stores of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 15 Colbert Business Pkwy W, Colbert, GA 30628-2462 | 2010-01-04 |
| 1104134469 | Southern Medical Transport | Non-emergency Medical Transport (VAN) | 276 Kincaid Cemetery Rd, Colbert, GA 30628-2547 | 2010-09-21 |
| 1447443361 | Robyn Cain Crouse | Physical Therapist | 1450 Old Kincaid Rd, Colbert, GA 30628-2559 | 2007-08-23 |
| Find all providers in zip 30628 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588642771 | Nicole Ford | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2006-01-06 |
| 1477176600 | Dallas Louis | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2020-05-21 |
| 1144849233 | Sarah Sammons | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2020-04-09 |
| 1174184030 | Evan Grovenstein | Nurse Practitioner | 11 Charlie Morris Rd, Colbert, GA 30628-2445 | 2019-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285486 | Aprn Mobile Clinic LLC | Nurse Practitioner | 1361 Highwoods Pass, Grovetown, GA 30813-3994 | 2020-11-08 |
| 1093316820 | Odyne Rose Lacossiere-dorvilus | Nurse Practitioner | 30 Myrtlewood Dr, Savannah, GA 31405-1024 | 2020-11-06 |
| 1104427061 | Tya Wright | Nurse Practitioner | 1450 Newnan Crossing Blvd E Apt 13205, Newnan, GA 30265-0027 | 2020-11-05 |
| 1235730409 | Cheryl Lynn Williams | Nurse Practitioner | 282 Somerset Dr, Dallas, GA 30132-9761 | 2020-11-04 |
| 1033710298 | Karen F Frazier | Nurse Practitioner | 6610 Crest Wood Ln, Douglasville, GA 30135-9046 | 2020-11-04 |
| 1619578986 | Marjorie Sewannyana | Nurse Practitioner | 553 Camano Way, Mcdonough, GA 30253-8377 | 2020-11-03 |
| 1639770027 | Markesha Leshea Groomes | Nurse Practitioner | 209 N. Cuthbert, Colquitt, GA 39837-3515 | 2020-11-03 |
| 1265033625 | Ashley Thomas | Nurse Practitioner | 3750 Venture Dr Ste E4, Duluth, GA 30096-1863 | 2020-11-03 |
| 1558962894 | Anna Marie Kodama | Nurse Practitioner | 462 Furys Ferry Rd # C, Augusta, GA 30907-9506 | 2020-11-03 |
| 1093315848 | Tracy Tarvers | Nurse Practitioner | 129 Wolf Creek Dr N, Macon, GA 31210-9002 | 2020-10-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.