Provider Demographics
NPI:1063103323
Name:MAISONET, CARLOS
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:MAISONET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 BERKELEY OAK CIR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4959
Mailing Address - Country:US
Mailing Address - Phone:770-900-6249
Mailing Address - Fax:
Practice Address - Street 1:4920 BERKELEY OAK CIR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4959
Practice Address - Country:US
Practice Address - Phone:770-900-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service