Individual
MRS. JOANN L CARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
160 CLINIC AVE, CARROLLTON, GA 30117-4451
(770) 834-1008
(770) 834-2531
Mailing address
9488 LAKEVIEW CT, DOUGLASVILLE, GA 30135
(770) 947-4210
(770) 830-0990
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN130954CRNA
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000716394D
MEDICAID X OVER
GA
05
—
000716394I
—
GA
05
—
000716394J
—
GA
01
—
374945
B CROSS
GA
Enumeration date
01/24/2006
Last updated
05/11/2012
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