Individual
DUSTIN AL INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 812-9666
Mailing address
1608 DOGWOOD DR, OXFORD, AL 36203-2714
(256) 454-4269
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
137096
GA
Other
Enumeration date
05/31/2022
Last updated
05/31/2022
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