Provider Demographics
NPI:1306634571
Name:GADDIS, JUSTIN CLAY (MPH, MN, RN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CLAY
Last Name:GADDIS
Suffix:
Gender:M
Credentials:MPH, MN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 21ST AVE S APT 812
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2544
Mailing Address - Country:US
Mailing Address - Phone:256-609-0602
Mailing Address - Fax:
Practice Address - Street 1:200 21ST AVE S APT 812
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2544
Practice Address - Country:US
Practice Address - Phone:256-609-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program