Provider Demographics
NPI:1053950675
Name:MEDLIN, CARIE MARIE (RDN)
Entity type:Individual
Prefix:MRS
First Name:CARIE
Middle Name:MARIE
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 BRYAN ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3309
Mailing Address - Country:US
Mailing Address - Phone:404-683-4987
Mailing Address - Fax:
Practice Address - Street 1:642 BRYAN ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3309
Practice Address - Country:US
Practice Address - Phone:404-683-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003873
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANAOtherNA