Provider Demographics
NPI:1124859095
Name:MCLEGGON, CAROLITA CHRISTINA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CAROLITA
Middle Name:CHRISTINA
Last Name:MCLEGGON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 HIGHGROVE WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-7407
Mailing Address - Country:US
Mailing Address - Phone:618-514-5395
Mailing Address - Fax:
Practice Address - Street 1:3101 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1044
Practice Address - Country:US
Practice Address - Phone:404-315-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN263066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily