Healthcare Provider Details

I. General information

NPI: 1629438007
Provider Name (Legal Business Name): PAMELA CARTY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 1ST ST
MACON GA
31201-2825
US

IV. Provider business mailing address

575 1ST ST
MACON GA
31201-2825
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-9762
  • Fax:
Mailing address:
  • Phone: 478-743-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN206794
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71639
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: