Provider Demographics
NPI:1215079736
Name:ESCOBAR, CARLOS ALBERTO (NP-C)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 HIGHWAY 92
Mailing Address - Street 2:STE 200
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2998
Mailing Address - Country:US
Mailing Address - Phone:770-880-4517
Mailing Address - Fax:
Practice Address - Street 1:6460 HIGHWAY 92
Practice Address - Street 2:STE 200
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2998
Practice Address - Country:US
Practice Address - Phone:770-880-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225443208600000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208600000XAllopathic & Osteopathic PhysiciansSurgery