Individual
JOHN AUGUSTAVE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
259 JONESBORO RD, MCDONOUGH, GA 30253-3769
(770) 957-8666
(770) 957-0375
Mailing address
290 COUNTRY CLUB DR, SUITE220, STOCKBRIDGE, GA 30281-9069
(678) 284-6300
(678) 284-6336
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4944
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
678871499B
—
GA
01
—
P00404946
RR MEDICARE
GA
Enumeration date
11/23/2005
Last updated
03/16/2015
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