Provider Demographics
NPI:1538674650
Name:PERRY-DAVIS, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:PERRY-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:PERRY-DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:325 HAMILTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5500
Mailing Address - Country:US
Mailing Address - Phone:470-350-3881
Mailing Address - Fax:
Practice Address - Street 1:200 E PONCE DE LEON AVE STE 110
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3467
Practice Address - Country:US
Practice Address - Phone:404-501-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant