Individual
CASEY SALCEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
132 FRANKLIN SPRINGS ST STE A, ROYSTON, GA 30662-4134
(706) 621-7575
(833) 305-0340
Mailing address
1061 DOWDY RD STE 204, ATHENS, GA 30606-5700
(706) 621-7575
(833) 305-0340
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN184724
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003232886R
MEDICAID
GA
01
—
1699324707
NPI
GA
01
—
G17368B
MEDICARE PROVIDER ID
GA
01
—
RN184724
PROFESSIONAL LICENSE
GA
Enumeration date
09/11/2019
Last updated
12/12/2024
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