Provider Demographics
NPI:1770514259
Name:CARMICHAEL, SANDRA JEAN (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GROSS CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3643
Mailing Address - Country:US
Mailing Address - Phone:706-858-2161
Mailing Address - Fax:706-858-2688
Practice Address - Street 1:100 GROSS CRESCENT CIR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3643
Practice Address - Country:US
Practice Address - Phone:706-858-2000
Practice Address - Fax:865-291-3228
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036116207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00232694OtherRAILROAD MEDICARE
TN3144639OtherBLUE CROSS BLUE SHE OF TN
GAC70613Medicare UPIN
GAP00232694OtherRAILROAD MEDICARE