Provider Demographics
NPI:1912009572
Name:WANNA, CAROL DOOLEY (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DOOLEY
Last Name:WANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:250 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3490
Mailing Address - Country:US
Mailing Address - Phone:478-301-2362
Mailing Address - Fax:478-301-2272
Practice Address - Street 1:1327 STADIUM DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31207-8639
Practice Address - Country:US
Practice Address - Phone:478-301-2382
Practice Address - Fax:478-301-2391
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2020-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA043812207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBBXBMedicare ID - Type Unspecified
GAF90633Medicare UPIN