Healthcare Provider Details

I. General information

NPI: 1215079736
Provider Name (Legal Business Name): CARLOS ALBERTO ESCOBAR NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 HIGHWAY 92 STE 200
ACWORTH GA
30102-2998
US

IV. Provider business mailing address

6460 HIGHWAY 92 STE 200
ACWORTH GA
30102-2998
US

V. Phone/Fax

Practice location:
  • Phone: 770-880-4517
  • Fax:
Mailing address:
  • Phone: 770-880-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRN225443
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN225443
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: