Provider Demographics
NPI:1902589237
Name:CARSON, MAKAYLA A (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MAKAYLA
Middle Name:A
Last Name:CARSON
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4110
Mailing Address - Country:US
Mailing Address - Phone:478-484-4193
Mailing Address - Fax:
Practice Address - Street 1:4837 BILL GARDNER PKWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3735
Practice Address - Country:US
Practice Address - Phone:770-461-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA278559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine