Provider Demographics
NPI:1366829095
Name:PRICE, CORIE (NP-C)
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CLINIC AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4454
Mailing Address - Country:US
Mailing Address - Phone:770-214-2800
Mailing Address - Fax:770-214-2803
Practice Address - Street 1:157 CLINIC AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4454
Practice Address - Country:US
Practice Address - Phone:770-214-2800
Practice Address - Fax:770-214-2803
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003160872Medicaid
GA20250I1273Medicare PIN