Provider Demographics
NPI:1700984432
Name:PRICE, CARLA M (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1689 OLD PENDERGRASS RD STE 340
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2716
Mailing Address - Country:US
Mailing Address - Phone:706-708-2344
Mailing Address - Fax:706-708-2342
Practice Address - Street 1:1689 OLD PENDERGRASS RD STE 340
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2716
Practice Address - Country:US
Practice Address - Phone:706-708-2344
Practice Address - Fax:706-708-2342
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA049410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA725588860AMedicaid
GA870335OtherBLUE SHIELD
GA870335OtherBLUE SHIELD
GA725588860AMedicaid