Provider Demographics
NPI:1861480980
Name:MONTES, CAROLINA M (MD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:M
Last Name:MONTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8347
Mailing Address - Country:US
Mailing Address - Phone:855-422-5628
Mailing Address - Fax:205-579-9387
Practice Address - Street 1:6240 SHILOH RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8347
Practice Address - Country:US
Practice Address - Phone:855-422-5628
Practice Address - Fax:205-579-9387
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47041207ND0900X, 207ZP0102X
LA200780207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582549Medicaid
LA4K417Medicare PIN
I08436Medicare UPIN
TN103I225354Medicare PIN