# JOHN AUGUSTAVE CARLSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1023091964
- **Gender:** Man
- **Credential:** PAC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 4944 | GA | Yes |

## Other

- **Enumeration date:** 11/23/2005
- **Last updated:** 03/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 678871499B | — | GA |
| 01 | — | P00404946 | RR MEDICARE | GA |