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General NPI Number Information
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NPI Number | 1639784119
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Entity Type | Individual
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Provider Name | CAROLINE N/A GUAN C-AA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 1377 DRESDEN DR NE APT 5117
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3457
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Country | US
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Telephone | 678-314-4302
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Fax |
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Provider Business Mailing Address
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Address Line | 1377 DRESDEN DR NE APT 5117
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3457
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Country | US
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Telephone | 678-314-4302
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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