Healthcare Provider Details

I. General information

NPI: 1952807166
Provider Name (Legal Business Name): ANN-GELLE CARTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 DIXIE ST STE 350
CARROLLTON GA
30117-3860
US

IV. Provider business mailing address

706 DIXIE ST STE 220
CARROLLTON GA
30117-3889
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-5831
  • Fax: 770-812-5832
Mailing address:
  • Phone: 770-838-8710
  • Fax: 770-812-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number88883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: