Provider Demographics
NPI:1316968969
Name:PRICE, CAROL L (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LEIGH
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1270 MCCONNELL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-321-4567
Mailing Address - Fax:404-321-0926
Practice Address - Street 1:1270 MCCONNELL DR
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-321-4567
Practice Address - Fax:404-321-0926
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics