Provider Demographics
NPI:1760617633
Name:WEST, CAROLYN G (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:G
Last Name:WEST
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 BROTHERS DR
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-2953
Mailing Address - Country:US
Mailing Address - Phone:334-332-4040
Mailing Address - Fax:
Practice Address - Street 1:2021 N. DRUID HILL RD. NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-325-0080
Practice Address - Fax:404-325-0085
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-021971363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health