Healthcare Provider Details

I. General information

NPI: 1316614902
Provider Name (Legal Business Name): CAROLINE BARWICK WALLACE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE MCCRAY BARWICK CRNA

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8917
  • Fax: 404-303-3636
Mailing address:
  • Phone: 404-851-8917
  • Fax: 404-303-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-CRNA278771
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: