Provider Demographics
NPI:1154110096
Name:SAUCEDO, DAVID J (NP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1360 CADUCEUS WAY
Mailing Address - Street 2:BUILDING 400 SUITE 104
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677
Mailing Address - Country:US
Mailing Address - Phone:706-850-8135
Mailing Address - Fax:706-548-9101
Practice Address - Street 1:1088A BAXTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6316
Practice Address - Country:US
Practice Address - Phone:706-353-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily