Basic Information
| Provider Information | |||||||||
| NPI: | 1568405199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAHL | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1955 LAKE PARK DR | ||||||||
| Address2: | STE. 250 | ||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782237700 | ||||||||
| FaxNumber: | 6782237798 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 JOHNSON FERRY RD | ||||||||
| Address2: | STE. 940 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048516000 | ||||||||
| FaxNumber: | 4042522736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 10/25/2012 | ||||||||
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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 | 363LA2200X | RN221492 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | P00176813 | 01 | AL | RAILROAD MEDICARE | OTHER | 051502843 | 01 | AL | BLUE CROSS | OTHER | 051519461 | 05 | AL | MEDICAID | 009963250 | 05 | AL | MEDICAID | 009963240 | 05 | AL | MEDICAID | 051519461 | 01 | AL | BLUE CROSS | OTHER | 051502841 | 05 | AL | MEDICAID | 051503289 | 01 | AL | BC FEDERAL EHBP | OTHER | 051502841 | 01 | AL | BLUE CROSS | OTHER | Q03243 | 01 | AL | VIVA | OTHER | 051502842 | 01 | AL | BLUE CROSS | OTHER |