Provider Demographics
NPI:1477888717
Name:LOGUE, CARRIE KLINGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:KLINGER
Last Name:LOGUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:KLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3834 PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3361
Mailing Address - Country:US
Mailing Address - Phone:404-239-0317
Mailing Address - Fax:404-237-6522
Practice Address - Street 1:3834 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-3361
Practice Address - Country:US
Practice Address - Phone:404-239-0317
Practice Address - Fax:404-237-6522
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist