MEDICARE: MELISSA CARTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1023685849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CARTER

Provider Business Mailing Address
First Line	:	5751 RIVERDALE RD APT 12B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8588
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5751 RIVERDALE RD APT 12B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8588
Country	:	US
Telephone Number	:	404-398-8497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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Directions to “ MELISSA CARTER ” Practice Location

Language	Start Address	Practice Location

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