Carolynn Anne Desandre, PHD, CMN, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Dahlonega, GA
NPI 1780703306 · NPPES record last updated May 30, 2017
Key facts
- NPI
- 1780703306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN113863 (GA)
- Practice address
- 134 Ansley Dr
Suite 200
Dahlonega, GA 30533-1640 - Phone
- (706) 864-2155
- Fax
- (706) 374-7628
- NPI assigned
- Mar 28, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN113863 | GA | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia Mountains Health Services, Inc. | Current | Accepting new patients |
Locations
165 Blue Ridge Overlook
Blue Ridge, GA 30513
Phone (706) 946-4647
Interoperability endpoints
- carolynn.desandre@gamtnhealth.gadirect.net
- carolynn.desandre.1@14358.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | RN113863 | GA | |
| Family Nurse Practitioner | 363LF0000X | RN113863 | GA | Yes |
Addresses
Primary practice location
134 Ansley Dr
Suite 200
Dahlonega, GA 30533-1640
Mailing address
165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Phone (706) 946-5600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003133660B | Medicaid | GA |
Other providers in Dahlonega, GA
- Kelley Davis Dasinger
- Michael Craig Dasinger
- Joshua Davidson
- Leo Davis
- DCLC Two PC
- Diabetic & Therapeutic Healthcare Supplies, LLC
- Dogwood Bluff Personal Care Home
- Lindsay Fowler Dowis
- Dr Anon Eugene Westmoreland Jr MD
- Dr. Baers Wellness Care LLC
All providers in Dahlonega, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.