Healthcare Provider Details

I. General information

NPI: 1497984603
Provider Name (Legal Business Name): CARLIE ANN FREDERICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 16TH AVE
COLUMBUS GA
31901-1665
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE 2001A
COLUMBUS GA
31904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-3700
  • Fax:
Mailing address:
  • Phone: 706-320-3126
  • Fax: 706-320-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN095043
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN095043
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: