Provider Demographics
NPI:1457537276
Name:PURVIS, CAROL E
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:PURVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1827
Mailing Address - Country:US
Mailing Address - Phone:478-445-5546
Mailing Address - Fax:478-445-6769
Practice Address - Street 1:430 N JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2919
Practice Address - Country:US
Practice Address - Phone:478-445-5546
Practice Address - Fax:478-445-6769
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN065013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse