Healthcare Provider Details

I. General information

NPI: 1023330164
Provider Name (Legal Business Name): CARLA FLOWERS DUFFIE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST ROOM BI-2144
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST ROOM BI-2144
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3873
  • Fax: 706-721-7763
Mailing address:
  • Phone: 706-721-3873
  • Fax: 706-721-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN164934 CRNA
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: