Provider Demographics
NPI:1891305744
Name:HUERTAS AYALA, CAROLINA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:HUERTAS AYALA
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 1:4500 NORTH SHALLOWFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-0000
Mailing Address - Country:US
Mailing Address - Phone:404-778-6920
Mailing Address - Fax:404-778-6811
Practice Address - Street 1:4500 NORTH SHALLOWFORD ROAD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-0000
Practice Address - Country:US
Practice Address - Phone:404-778-6920
Practice Address - Fax:404-778-6811
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program