CALEB ELISHA ETHERIDGE (NPI# 1225670532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225670532 |
| Entity Type | Individual |
| Full Name | CALEB ELISHA ETHERIDGE |
| Credential | PA-C |
| Practice Address |
1825 Martha Berry Blvd Nw Rome GA 30165-1625 |
| Mailing Address |
221 Technology Pkwy Nw Rome GA 30165-1369 |
| Practice Telephone | 7622352700 |
| Practice Fax Number | 7062366437 |
| Mailing Telephone | 7622351000 |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2020-05-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 9480 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1825 MARTHA BERRY BLVD NW |
| City | ROME |
| State | GA |
| Zip Code | 30165-1625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932104924 | Natasha Amanda Sands | Family Medicine | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2005-06-16 |
| 1922605401 | Lauryn Goss Vines | Nurse Practitioner | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2020-10-07 |
| 1508479536 | Emily Adams Thornberry | Nurse Practitioner | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2020-08-28 |
| 1831738368 | Lori Patricia Bain | Nurse Practitioner | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2020-01-01 |
| 1306498118 | Allison Heidi Pledger | Nurse Practitioner | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2019-07-11 |
| 1396301180 | Julie Goulding Shrewsbury | Nurse Practitioner | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2019-05-16 |
| 1346725264 | Lacy Holland Lacey | Nurse Practitioner | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2018-09-26 |
| 1215439286 | Swaraj Suhas Hublikar | Physician Assistant | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2018-03-06 |
| 1245740828 | Ashley Marie Gaulin | Physician Assistant | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2017-10-09 |
| 1609394261 | Mollie Lynn Mccormick | Physician Assistant | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2017-09-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
| Find all providers in zip 30165 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518587781 | Chandler Holcombe | Physician Assistant | 100 Three Rivers Dr Ne, Rome, GA 30161-4999 | 2020-04-17 |
| 1609400886 | Morgan Elise Benson Baker | Physician Assistant | 123 Three Rivers Dr Ne, Rome, GA 30161-2300 | 2020-02-26 |
| 1548805401 | Mallory Elizabeth Osborne | Physician Assistant | 330 Turner Mccall Blvd Sw, Rome, GA 30165-5630 | 2019-11-14 |
| 1710522933 | William Edward Johnson | Physician Assistant | 550 Redmond Rd Nw, Rome, GA 30165-1416 | 2019-11-12 |
| 1659934321 | Tara Simonson | Physician Assistant | 310 W 10th St Ne, Rome, GA 30165-2639 | 2019-04-18 |
| 1255805180 | Amanda Lynn Preteroti | Physician Assistant | 504 Redmond Rd Nw, Rome, GA 30165-1416 | 2019-01-14 |
| 1528535036 | Jaskirt Kaur Chahal | Physician Assistant | 1617 N James St, Rome, NY 13440-2852 | 2018-11-01 |
| 1205311131 | Austin James Malcom | Physician Assistant | 550 Redmond Rd Nw, Rome, GA 30165-1416 | 2018-09-26 |
| 1215439286 | Swaraj Suhas Hublikar | Physician Assistant | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2018-03-06 |
| 1245740828 | Ashley Marie Gaulin | Physician Assistant | 1825 Martha Berry Blvd Nw, Rome, GA 30165-1625 | 2017-10-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.