Provider Demographics
NPI:1649212192
Name:CAROUSEL PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:CAROUSEL PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-834-0606
Mailing Address - Street 1:804 DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4416
Mailing Address - Country:US
Mailing Address - Phone:770-834-0606
Mailing Address - Fax:770-834-1833
Practice Address - Street 1:804 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4416
Practice Address - Country:US
Practice Address - Phone:770-834-0606
Practice Address - Fax:770-834-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty