Provider Demographics
NPI:1033995816
Name:CARMON, CARRIE WARE (LMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:WARE
Last Name:CARMON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:WARE
Other - Last Name:MAXBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5675 ROSWELL RD APT 59K
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 W WIEUCA RD NE STE 239
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3290
Practice Address - Country:US
Practice Address - Phone:678-886-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT-0006279225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist