Healthcare Provider Details

I. General information

NPI: 1548424864
Provider Name (Legal Business Name): LASHONDA CARTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 CLAYTS CIR
MACON GA
31216-5403
US

IV. Provider business mailing address

PO BOX 870263
MORROW GA
30287-0263
US

V. Phone/Fax

Practice location:
  • Phone: 678-463-1588
  • Fax: 678-463-1588
Mailing address:
  • Phone: 678-463-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN135688
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN135688NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: