Provider Demographics
NPI:1952383192
Name:SCULLY, CAROL J (CNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:SCULLY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 MARIETTA HWY
Mailing Address - Street 2:BLDG A
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1836
Mailing Address - Country:US
Mailing Address - Phone:678-945-8200
Mailing Address - Fax:678-945-8209
Practice Address - Street 1:176 MARIETTA HWY
Practice Address - Street 2:BLDG A
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-1836
Practice Address - Country:US
Practice Address - Phone:678-945-8200
Practice Address - Fax:678-945-8209
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151311363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner