Provider Demographics
NPI:1699988071
Name:POLINE, CARRIE RACHEL (DO)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:RACHEL
Last Name:POLINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:RACHEL
Other - Last Name:MAZER-POLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4536 BARCLAY DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7145
Mailing Address - Country:US
Mailing Address - Phone:770-458-8711
Mailing Address - Fax:
Practice Address - Street 1:4536 BARCLAY DR
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7145
Practice Address - Country:US
Practice Address - Phone:770-458-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA647372084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry