Healthcare Provider Details

I. General information

NPI: 1396652285
Provider Name (Legal Business Name): KALLAN NOELLE CARPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E 1ST AVE STE 701
ROME GA
30161-3216
US

IV. Provider business mailing address

314 E 1ST AVE STE 701
ROME GA
30161-3216
US

V. Phone/Fax

Practice location:
  • Phone: 706-314-8504
  • Fax:
Mailing address:
  • Phone: 706-314-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018555
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: