Provider Demographics
NPI:1598417768
Name:CARSON, JUSTIN J (RN)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:CARSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 PRINCESS HELEN RD W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-3043
Mailing Address - Country:US
Mailing Address - Phone:404-623-1868
Mailing Address - Fax:
Practice Address - Street 1:134 BALDWIN AVE APT 805
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1911
Practice Address - Country:US
Practice Address - Phone:404-623-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-183223163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse