Provider Demographics
NPI:1699889865
Name:CARBONELL, NICOLE P (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:P
Last Name:CARBONELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14030 CRABAPPLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4264
Mailing Address - Country:US
Mailing Address - Phone:678-462-1711
Mailing Address - Fax:
Practice Address - Street 1:3950 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1121
Practice Address - Country:US
Practice Address - Phone:770-732-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056417207P00000X
AL25112207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6611384100OtherDOL
GA244750062DMedicaid
GA244750062CMedicaid
GA244750062AMedicaid
GA244750062BMedicaid
GA244750062AMedicaid
GA244750062DMedicaid