Provider Demographics
NPI:1033152665
Name:PASS, CARSON GIVENS (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARSON
Middle Name:GIVENS
Last Name:PASS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2744
Mailing Address - Country:US
Mailing Address - Phone:770-254-1540
Mailing Address - Fax:
Practice Address - Street 1:6135 ROOSEVELT HIGHWAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830
Practice Address - Country:US
Practice Address - Phone:706-655-5738
Practice Address - Fax:706-655-5742
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist