Individual
TIA CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9798 MUSKET RIDGE CIR, JONESBORO, GA 30238-6712
(404) 388-9209
Mailing address
9798 MUSKET RIDGE CIR, JONESBORO, GA 30238-6712
(404) 388-9209
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN163876
GA
163WC0400X
Case Management Registered Nurse
RN163876
GA
163WC1500X
Community Health Registered Nurse
RN163876
GA
163WH0200X
Home Health Registered Nurse
RN163876
GA
163WW0000X
Wound Care Registered Nurse
RN163876
GA
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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