Healthcare Provider Details

I. General information

NPI: 1043204969
Provider Name (Legal Business Name): TRACY ANDREA CARSTARPHEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY ANDREA RICHARDSON

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 MERIDIAN MARKS RD
ATLANTA GA
30342
US

IV. Provider business mailing address

2651 CEDAR DR
LAWRENCEVILLE GA
30043-1325
US

V. Phone/Fax

Practice location:
  • Phone: 615-673-6737
  • Fax: 800-474-4039
Mailing address:
  • Phone: 615-673-6737
  • Fax: 800-474-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201683
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number201683
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number165081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: