Provider Demographics
NPI:1124034012
Name:SLOAN, CARRIE L (MDLLC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MDLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198546
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:96 E KIMBALLS LN STE 202
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5021
Practice Address - Country:US
Practice Address - Phone:801-523-3053
Practice Address - Fax:801-523-3059
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5666633-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH36731Medicare UPIN
UT005791801Medicare ID - Type Unspecified
000057918Medicare PIN