Healthcare Provider Details

I. General information

NPI: 1639206907
Provider Name (Legal Business Name): CAROL B LEVY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 RIDGEWOOD DR NE
ATLANTA GA
30322-1031
US

IV. Provider business mailing address

2004 RIDGEWOOD DR NE
ATLANTA GA
30322-1031
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-0399
  • Fax: 404-727-6091
Mailing address:
  • Phone: 404-727-0399
  • Fax: 404-727-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN036742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: