Healthcare Provider Details

I. General information

NPI: 1891546925
Provider Name (Legal Business Name): CAROLYN FAYE WEST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7392 SKYLANE DR
RIVERDALE GA
30296-1439
US

IV. Provider business mailing address

6992 CHESWICK DR
RIVERDALE GA
30296-2258
US

V. Phone/Fax

Practice location:
  • Phone: 404-259-1331
  • Fax:
Mailing address:
  • Phone: 404-955-1463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number010208
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN128056
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: