Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0011X | Interventional Cardiology | 95009058 | CA |
Y | 207RI0011X | Interventional Cardiology | 95009058 | GA |
NPI | 1023585395 |
---|---|
Provider Name | Stacy Ann Cartmell |
First Address | Canton, GA 30115-8555 |
Second Address | Canton, GA 30115-8015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 26/02/2021 |