Healthcare Provider Details

I. General information

NPI: 1104325828
Provider Name (Legal Business Name): JAMES ALLAN CAREY NNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901-2603
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2331
  • Fax: 706-721-7531
Mailing address:
  • Phone: 706-446-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN130455
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: