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General NPI Number Information
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NPI Number | 1780703306
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Entity Type | Individual
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Provider Name | CAROLYNN ANNE DESANDRE PHD, CMN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 05/30/2017
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Provider Practice Location Address
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Address Line | 134 ANSLEY DR SUITE 200
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City | DAHLONEGA
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State | GA
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Zip | 30533-1640
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Country | US
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Telephone | 706-864-2155
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Fax | 706-374-7628
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Provider Business Mailing Address
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Address Line | 165 BLUE RIDGE OVERLOOK
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4431
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Country | US
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Telephone | 706-946-5600
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Fax | 706-374-7628
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | RN113863
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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 | RN113863
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License Number State | GA
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