Healthcare Provider Details

I. General information

NPI: 1285540542
Provider Name (Legal Business Name): MRS. CAROLYN A R CORBETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 NEVIS WAY
MCDONOUGH GA
30253-8390
US

IV. Provider business mailing address

974 NEVIS WAY
MCDONOUGH GA
30253-8390
US

V. Phone/Fax

Practice location:
  • Phone: 770-825-3358
  • Fax:
Mailing address:
  • Phone: 770-825-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN128817
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: