Basic Information
| Provider Information | |||||||||
| NPI: | 1144375106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARLICH | ||||||||
| FirstName: | CARO | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FEAGIN | ||||||||
| OtherFirstName: | CARO | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 JESSE JEWELL PKWY SE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702972200 | ||||||||
| FaxNumber: | 7705348139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 058875 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | 058875 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 848011178E | 05 | GA | MEDICAID | 550182 | 01 | GA | COVENTRY | OTHER | 2552306 | 01 | GA | CIGNA | OTHER | 403495 | 01 | GA | WELLCARE | OTHER | 52210430 | 01 | GA | BCBS | OTHER | 848011178A | 05 | GA | MEDICAID | 848011178C | 01 | GA | PEACH STATE | OTHER | 848011178C | 05 | GA | MEDICAID | 2536163 | 01 | GA | UHC | OTHER | 848011178A | 01 | GA | PEACH STATE | OTHER | 7307717 | 01 | GA | AETNA | OTHER | 01053164 | 01 | GA | AMERIGROUP | OTHER | 848011178D | 05 | GA | MEDICAID | 848011178F | 05 | GA | MEDICAID | P00410670 | 01 | GA | RAILROAD MEDICARE | OTHER |