Provider Demographics
NPI:1598462400
Name:NEEL, CARSON GAFFORD
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:GAFFORD
Last Name:NEEL
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 1:1112 E PRYOR ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2162
Mailing Address - Country:US
Mailing Address - Phone:256-497-3066
Mailing Address - Fax:
Practice Address - Street 1:22136 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2940
Practice Address - Country:US
Practice Address - Phone:256-648-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1171846363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics