Healthcare Provider Details

I. General information

NPI: 1912773631
Provider Name (Legal Business Name): FATI MELANIE CARTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

504 BENTMOOR DR
HELENA AL
35080-8101
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax:
Mailing address:
  • Phone: 205-213-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1-114183
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: