=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619985785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE R. CARRICK D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 03/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 W UNION ST
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-594-9181
-----------------------------------------------------
Fax | 740-594-8042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14826 MANSFIELD RD
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701-9447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-594-9181
-----------------------------------------------------
Fax | 740-594-8042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 34004229
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------