Provider Demographics
NPI:1427652247
Name:CARNES, BRIAN M (MT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:CARNES
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 957362
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9523
Mailing Address - Country:US
Mailing Address - Phone:770-480-7861
Mailing Address - Fax:
Practice Address - Street 1:6110 MCFARLAND STATION DR UNIT 400
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6806
Practice Address - Country:US
Practice Address - Phone:770-851-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001767225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist