Provider Demographics
NPI:1033315122
Name:CARROLL, SUNI HAMM (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUNI
Middle Name:HAMM
Last Name:CARROLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 RIVERBEND DR SW
Mailing Address - Street 2:STE 200
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6005
Mailing Address - Country:US
Mailing Address - Phone:706-291-0884
Mailing Address - Fax:706-378-8267
Practice Address - Street 1:1105 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2603
Practice Address - Country:US
Practice Address - Phone:706-291-0884
Practice Address - Fax:706-378-8267
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119358363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA766297560AMedicaid
GA766297560AMedicaid