MEDICARE: TANGIE CARTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator	GA
2	172A00000X	Driver
3	305S00000X	Point of Service	GA
4	390200000X	Student in an Organized Health Care Education/Training Program	GA

General Provider Information

NPI Number	:	1578992749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANGIE CARTER

Provider Business Mailing Address
First Line	:	30 S CLAYTON ST APT 1230
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-5767
Country	:	US
Telephone Number	:	706-315-4327
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 S CLAYTON ST APT 1230
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-5767
Country	:	US
Telephone Number	:	678-337-2515
Fax Number	:

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	04/29/2026

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Directions to “ TANGIE CARTER ” Practice Location

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