Provider Demographics
NPI:1639784119
Name:GUAN, CAROLINE N/A (C-AA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:N/A
Last Name:GUAN
Suffix:
Gender:F
Credentials:C-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 DRESDEN DR NE APT 5117
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3457
Mailing Address - Country:US
Mailing Address - Phone:678-314-4302
Mailing Address - Fax:
Practice Address - Street 1:1377 DRESDEN DR NE APT 5117
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3457
Practice Address - Country:US
Practice Address - Phone:678-314-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-23
Deactivation Date:2020-09-15
Deactivation Code:
Reactivation Date:2020-09-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant