Individual
MR. CORWIN JOHN ATADDLETY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
423 N 1ST ST, ANADARKO, OK 73005-2111
(405) 247-2428
Mailing address
221 WICHITA DR, ANADARKO, OK 73005-3705
(405) 933-2258
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
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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