Provider Demographics
NPI:1790399475
Name:ROSS, CAROL (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:CAROL
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:550 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1416
Practice Address - Country:US
Practice Address - Phone:762-235-3550
Practice Address - Fax:706-233-8515
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143376363L00000X
GA143376208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner