Provider Demographics
NPI:1104972801
Name:CARROLL, PAULA (CRNA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 IDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-6507
Mailing Address - Country:US
Mailing Address - Phone:706-436-0730
Mailing Address - Fax:
Practice Address - Street 1:155 IDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-6507
Practice Address - Country:US
Practice Address - Phone:706-436-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097148367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000786453IMedicaid
GA000786453EMedicaid
GA000786453JMedicaid
GA000786453IMedicaid