Healthcare Provider Details

I. General information

NPI: 1679073464
Provider Name (Legal Business Name): CAROLYN JOY FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 WATSON BLVD
WARNER ROBINS GA
31093-3634
US

IV. Provider business mailing address

2054 WATSON BLVD
WARNER ROBINS GA
31093-3634
US

V. Phone/Fax

Practice location:
  • Phone: 478-918-0770
  • Fax:
Mailing address:
  • Phone: 478-918-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number119019
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN119019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: