Provider Demographics
NPI:1548992480
Name:GADDY, OLIVIA HART
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:HART
Last Name:GADDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 JONES RD
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-3716
Mailing Address - Country:US
Mailing Address - Phone:731-345-9428
Mailing Address - Fax:
Practice Address - Street 1:7019 HIGHWAY 412 S
Practice Address - Street 2:
Practice Address - City:BELLS
Practice Address - State:TN
Practice Address - Zip Code:38006-4140
Practice Address - Country:US
Practice Address - Phone:731-663-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist