Healthcare Provider Details

I. General information

NPI: 1134772049
Provider Name (Legal Business Name): CARLY THAMER DONNET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 POPLAR RD STE 160
NEWNAN GA
30265-8302
US

IV. Provider business mailing address

403 HOLLY BROOK LN
PEACHTREE CITY GA
30269-3069
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-4630
  • Fax:
Mailing address:
  • Phone: 404-408-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN248778
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN248778
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: