Provider Demographics
NPI:1912471137
Name:OVERGAARD, CAROLINE WOODALL (RN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WOODALL
Last Name:OVERGAARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ANNA
Other - Last Name:WOODALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:312 HABERSHAM RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9511
Mailing Address - Country:US
Mailing Address - Phone:706-533-3314
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209623367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN209623OtherCRNA LICENSE