MEDICARE: CARMEN WAUGH CSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	4847	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000000	OTHER	GA	CIGNA. BLUE CROSS, BLUE SHIELD, AETNA
2	4847	OTHER	GA	CERTIFICATION

General Provider Information

NPI Number	:	1275087462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN WAUGH CSA

Provider Business Mailing Address
First Line	:	8108 ROSEFINCH LNDG
Second Line	:
City	:	HOSCHTON
State	:	GA
Zip	:	30548-4244
Country	:	US
Telephone Number	:	678-789-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 HIGHWAY 211 NW # 147-2F
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-3402
Country	:	US
Telephone Number	:	678-789-3057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	08/07/2025

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