Healthcare Provider Details

I. General information

NPI: 1235713538
Provider Name (Legal Business Name): CAROL L HERRMANN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E PONCE DE LEON AVE STE 235
DECATUR GA
30030-2553
US

IV. Provider business mailing address

150 E PONCE DE LEON AVE STE 235
DECATUR GA
30030-2553
US

V. Phone/Fax

Practice location:
  • Phone: 404-378-1998
  • Fax:
Mailing address:
  • Phone: 404-378-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROL LYNN HERRMANN
Title or Position: OWNER
Credential: MD
Phone: 404-378-1998