Provider Demographics
NPI:1336716174
Name:NOLAN, GERARD CHRISTIAN CARBONELL (CRNP)
Entity Type:Individual
Prefix:
First Name:GERARD CHRISTIAN
Middle Name:CARBONELL
Last Name:NOLAN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOODFIN LN
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-8732
Mailing Address - Country:US
Mailing Address - Phone:205-755-3500
Mailing Address - Fax:
Practice Address - Street 1:1320 WOODFIN LN
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-8732
Practice Address - Country:US
Practice Address - Phone:205-755-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty