Healthcare Provider Details

I. General information

NPI: 1669335733
Provider Name (Legal Business Name): ANNA M CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11172 GA-142
COVINGTON GA
36830
US

IV. Provider business mailing address

535 MOORES MILL RD
AUBURN AL
36830-6027
US

V. Phone/Fax

Practice location:
  • Phone: 678-712-3692
  • Fax:
Mailing address:
  • Phone: 334-744-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA12540
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: