=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508857376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARLA PAIGE MASSEY PHARMD.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 HOSPITAL RD
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30114-2408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-720-5272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1591 UPPER SWEETWATER TRL SE
-----------------------------------------------------
City | WHITE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30184-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-720-7252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH019228
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------