Provider Demographics
NPI:1154720860
Name:MAGUIRE, CARRIE ALLEN (CPNP, PMHS)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ALLEN
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:CPNP, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 CHEROKEE STREET NW
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6787
Mailing Address - Country:US
Mailing Address - Phone:770-429-1005
Mailing Address - Fax:
Practice Address - Street 1:3745 CHEROKEE STREET NW
Practice Address - Street 2:SUITE 401
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6787
Practice Address - Country:US
Practice Address - Phone:770-429-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201380363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics