Healthcare Provider Details

I. General information

NPI: 1427877281
Provider Name (Legal Business Name): CARISSA MEREA DUVALL MSN, APRN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 PIEDMONT RD NE STE B
ATLANTA GA
30305-2784
US

IV. Provider business mailing address

4903 JUDITH AVE SE
ACWORTH GA
30102-2867
US

V. Phone/Fax

Practice location:
  • Phone: 404-841-9445
  • Fax:
Mailing address:
  • Phone: 678-477-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN330541
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN330541
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN330541
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN330541
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: