Healthcare Provider Details

I. General information

NPI: 1881602274
Provider Name (Legal Business Name): HEATHER A CARL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 HEMBREE RD STE 101
ROSWELL GA
30076-5721
US

IV. Provider business mailing address

3390 PEACHTREE RD NE STE 1500
ATLANTA GA
30326
US

V. Phone/Fax

Practice location:
  • Phone: 404-920-4950
  • Fax: 404-920-4959
Mailing address:
  • Phone: 404-920-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN144436
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: