Funlola M Gaddis, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN186624 Issued in GA

Practice address

1365 Rock Quarry Rd
Suite 301
Stockbridge, GA 30281-5029

Phone

(770) 771-6580

NPI assigned

Sep 7, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Funlola M Awoyemi Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1962783639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 ROCK QUARRY RD",
            "address_2": "SUITE 301",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815029",
            "telephone_number": "770-771-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 ROCK QUARRY RD",
            "address_2": "SUITE 301",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815029",
            "telephone_number": "770-771-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADDIS",
        "first_name": "FUNLOLA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-07",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN186624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FUNLOLA",
            "last_name": "AWOYEMI",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Varon Alexander Garcias, MD

• Family Nurse Practitioner in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.