Healthcare Provider Details

I. General information

NPI: 1033978648
Provider Name (Legal Business Name): JAMIE LEIGH CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N OAK STREET EXT
VALDOSTA GA
31605-1014
US

IV. Provider business mailing address

3301 N OAK STREET EXT
VALDOSTA GA
31605-1014
US

V. Phone/Fax

Practice location:
  • Phone: 229-242-6061
  • Fax:
Mailing address:
  • Phone: 229-242-6061
  • Fax: 229-242-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP291974
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: