Provider Demographics
NPI:1134594351
Name:MCEACHRON, CARLENE (FNP)
Entity type:Individual
Prefix:MS
First Name:CARLENE
Middle Name:
Last Name:MCEACHRON
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 1:2890 GA HWY 212
Mailing Address - Street 2:SUITE A- 122
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 MARIETTA ST NW
Practice Address - Street 2:STE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2720
Practice Address - Country:US
Practice Address - Phone:404-947-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily