Provider Demographics
NPI:1942512033
Name:RAGAN, CARSON COOKE (CNM)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:COOKE
Last Name:RAGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:
Other - Last Name:BASHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 CAMPBELL HILL ST NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1134
Mailing Address - Country:US
Mailing Address - Phone:770-528-0260
Mailing Address - Fax:
Practice Address - Street 1:833 CAMPBELL HILL ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1134
Practice Address - Country:US
Practice Address - Phone:770-528-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife