Provider Demographics
NPI:1124826300
Name:NELSON, CASSENDA (CHW)
Entity type:Individual
Prefix:
First Name:CASSENDA
Middle Name:
Last Name:NELSON
Suffix:
Gender:
Credentials:CHW
Other - Prefix:
Other - First Name:CASSENDA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:110 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-2133
Mailing Address - Country:US
Mailing Address - Phone:229-669-0830
Mailing Address - Fax:229-669-0830
Practice Address - Street 1:110 THOMAS ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-2133
Practice Address - Country:US
Practice Address - Phone:229-669-0830
Practice Address - Fax:229-669-0830
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula