Healthcare Provider Details

I. General information

NPI: 1740126929
Provider Name (Legal Business Name): SHAKIYAH KIUNNA CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CLARKE STREET PO BOX 142
TALBOTTON GA
31827
US

IV. Provider business mailing address

176 CLARKE STREET PO BOX 142
TALBOTTON GA
31827
US

V. Phone/Fax

Practice location:
  • Phone: 912-536-9834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024196251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: