Provider Demographics
NPI:1063533073
Name:CARUSOS, PHYLLIS ANN (DC)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ANN
Last Name:CARUSOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 SANDY SPRINGS PL NE
Mailing Address - Street 2:SUITE J
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5918
Mailing Address - Country:US
Mailing Address - Phone:404-705-9339
Mailing Address - Fax:404-705-9133
Practice Address - Street 1:227 SANDY SPRINGS PL NE
Practice Address - Street 2:SUITE J
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5918
Practice Address - Country:US
Practice Address - Phone:404-705-9339
Practice Address - Fax:404-705-9133
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5403111N00000X
AL1661111N00000X
SC1946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU59921Medicare UPIN
GA35ZCDFKMedicare ID - Type Unspecified