Individual
CAROL JANE AYCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
3131 S MAIN ST, MOULTRIE, GA 31768-6925
(229) 891-9131
(229) 891-9079
Mailing address
PO BOX 40, MOULTRIE, GA 31776-0040
(229) 891-9131
(229) 891-9079
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R032218
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000490476B
—
GA
05
—
000490476D
—
GA
05
—
00490476B
—
GA
01
—
R032218
LICENSE
GA
Enumeration date
07/11/2006
Last updated
11/26/2008
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