Healthcare Provider Details

I. General information

NPI: 1235054230
Provider Name (Legal Business Name): ANGELICA CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
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

6600 KITTEN LAKE DR APT 812
MIDLAND GA
31820-3779
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN278141
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: