MEDICARE: WILLIAM CARSON

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	225700000X	Massage Therapist	MT004957	GA

General Provider Information

NPI Number	:	1285580084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM CARSON

Provider Business Mailing Address
First Line	:	3276 BUFORD DR STE 104-255
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-5702
Country	:	US
Telephone Number	:	770-605-5844
Fax Number	:

Provider Business Practice Location Address
First Line	:	2743 OLD PEACHTREE RD
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-2044
Country	:	US
Telephone Number	:	770-605-8442
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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