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Individual
MR. CORWIN JOHN ATADDLETY
Active
Individual
MR. CORWIN JOHN ATADDLETY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NULL
175T00000X
Peer Specialist
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034621147
SOONERCARE
OK
Enumeration date
06/29/2022
Last updated
01/06/2025
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