Provider Demographics
NPI:1104130368
Name:ANAELE, CAROLINE C (FNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:C
Last Name:ANAELE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 FAIRBURN ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1029
Mailing Address - Country:US
Mailing Address - Phone:678-594-3881
Mailing Address - Fax:678-594-3871
Practice Address - Street 1:2121 FAIRBURN ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1029
Practice Address - Country:US
Practice Address - Phone:678-594-3881
Practice Address - Fax:678-594-3871
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA456441108Medicaid
GA456441108Medicaid