Provider Demographics
NPI:1891546925
Name:WEST, CAROLYN FAYE (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FAYE
Last Name:WEST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6992 CHESWICK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2258
Mailing Address - Country:US
Mailing Address - Phone:404-955-1463
Mailing Address - Fax:
Practice Address - Street 1:7392 SKYLANE DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1439
Practice Address - Country:US
Practice Address - Phone:404-259-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128056163WA2000X
GA010208310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator