Provider Demographics
NPI:1588045074
Name:WOOLERY, CARREN
Entity Type:Individual
Prefix:
First Name:CARREN
Middle Name:
Last Name:WOOLERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W CROGAN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4735
Mailing Address - Country:US
Mailing Address - Phone:470-299-2090
Mailing Address - Fax:678-786-2037
Practice Address - Street 1:461 W CROGAN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4735
Practice Address - Country:US
Practice Address - Phone:678-308-9914
Practice Address - Fax:678-786-2037
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067R1293163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health