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Individual

DR. NICOLE P CARBONELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 732-4000
Mailing address
14030 CRABAPPLE LAKE DR, ROSWELL, GA 30076-4264
(678) 462-1711

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
056417
GA
207P00000X
Emergency Medicine Physician
25112
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
244750062A
GA
05
244750062B
GA
05
244750062C
GA
05
244750062D
GA
01
6611384100
DOL
GA
Enumeration date
08/17/2006
Last updated
12/30/2010
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