Individual
DR. CARISSA LEIGH CHALUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-2613
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OP61130040
WA
207P00000X
Emergency Medicine Physician
R9196
TX
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
6812
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56647-95
—
GA
Enumeration date
06/23/2014
Last updated
12/06/2021
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