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General NPI Number Information
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NPI Number | 1073915328
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Entity Type | Individual
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Provider Name | CARRIE SILAS FOGAL NP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 300 HOSPITAL RD
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City | FT GORDON
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State | GA
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Zip | 30905
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Country | US
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Telephone | 706-799-9915
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E HOSPITAL RD
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City | FORT GORDON
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-1247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN188256
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 188256
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 188256
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License Number State | GA
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