Provider Demographics
NPI:1568405199
Name:DAHL, CAROL W (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:W
Last Name:DAHL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 LAKE PARK DR
Mailing Address - Street 2:STE. 250
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:678-223-7700
Mailing Address - Fax:678-223-7798
Practice Address - Street 1:980 JOHNSON FERRY RD
Practice Address - Street 2:STE. 940
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-851-6000
Practice Address - Fax:404-252-2736
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221492363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00176813OtherRAILROAD MEDICARE
AL051502843OtherBLUE CROSS
AL051519461Medicaid
AL009963250Medicaid
AL009963240Medicaid
AL051519461OtherBLUE CROSS
AL051502841Medicaid
AL051503289OtherBC FEDERAL EHBP
AL051502841OtherBLUE CROSS
ALQ03243OtherVIVA
AL051502842OtherBLUE CROSS
AL051502842OtherBLUE CROSS
AL051503289OtherBC FEDERAL EHBP