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General NPI Number Information
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NPI Number | 1861744435
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Entity Type | Individual
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Provider Name | CAROLINE SPARKS FNP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 3596 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30005-4465
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Country | US
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Telephone | 770-559-5834
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Fax |
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Provider Business Mailing Address
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Address Line | 873 HALLBROOK LN
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City | MILTON
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State | GA
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Zip | 30004-3095
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Country | US
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Telephone | 678-206-7528
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN206033
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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 | F332073-1
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License Number State | NY
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