Healthcare Provider Details

I. General information

NPI: 1326983834
Provider Name (Legal Business Name): MADISON GRACE CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

177 OAKSIDE CIR
LEESBURG GA
31763-1840
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-5000
  • Fax:
Mailing address:
  • Phone: 229-449-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: