Individual
CARLA WILSON PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-1526
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST STE BI1056, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1-121795
AL
363L00000X
Nurse Practitioner
Primary
RN211008
GA
Other
Enumeration date
06/20/2016
Last updated
08/20/2020
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