Individual
MRS. KANDACE DANIELLE BIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 W THOMAS ST, MILLEDGEVILLE, GA 31061-2674
(478) 453-9346
Mailing address
800 W THOMAS ST, MILLEDGEVILLE, GA 31061-2674
(478) 453-9346
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1722
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
899248448A
—
GA
05
—
899248448B
—
GA
Enumeration date
05/19/2008
Last updated
03/02/2025
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