Healthcare Provider Details

I. General information

NPI: 1578942009
Provider Name (Legal Business Name): CARLA TATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLA BROWN FNP

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 LONGFIELD DR
SNELLVILLE GA
30039
US

IV. Provider business mailing address

316 COLLINGSWORTH TRCE
LAWRENCEVILLE GA
30043-7576
US

V. Phone/Fax

Practice location:
  • Phone: 205-492-2645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN204127
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRN204127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: