Healthcare Provider Details

I. General information

NPI: 1760317655
Provider Name (Legal Business Name): LEXIE LYNN COAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEXIE LYNN CARTER NP

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3050
US

IV. Provider business mailing address

4401 GLENHAVEN DR
DECATUR GA
30035-1418
US

V. Phone/Fax

Practice location:
  • Phone: 404-200-6541
  • Fax:
Mailing address:
  • Phone: 404-616-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG04260038
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberAG04260038
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG04260038
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: