Individual
STEPHANIE AMANDA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
3939 LAVISTA RD STE E, TUCKER, GA 30084-4847
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN216330
GA
363LP2300X
Primary Care Nurse Practitioner
RN216330
GA
Other
Enumeration date
03/09/2019
Last updated
03/10/2019
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