Healthcare Provider Details

I. General information

NPI: 1194100362
Provider Name (Legal Business Name): SARAH CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 ROUND POND RD
LA FAYETTE GA
30728-4710
US

IV. Provider business mailing address

3949 ROUND POND RD
LA FAYETTE GA
30728-4710
US

V. Phone/Fax

Practice location:
  • Phone: 423-314-1252
  • Fax:
Mailing address:
  • Phone: 423-314-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberLPN090474
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number86290
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: