Basic Information
| Provider Information | |||||||||
| NPI: | 1033315122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | SUNI | ||||||||
| MiddleName: | HAMM | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 RIVERBEND DR SW | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301616005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910884 | ||||||||
| FaxNumber: | 7063788267 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 N 5TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301652603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910884 | ||||||||
| FaxNumber: | 7063788267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | RN119358 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 766297560A | 05 | GA | MEDICAID |