Healthcare Provider Details

I. General information

NPI: 1881558641
Provider Name (Legal Business Name): T CARTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 ALICE ST
WAYCROSS GA
31501-4533
US

IV. Provider business mailing address

1610 ALICE ST
WAYCROSS GA
31501-4533
US

V. Phone/Fax

Practice location:
  • Phone: 912-590-4366
  • Fax:
Mailing address:
  • Phone: 912-590-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIERRA CARTER
Title or Position: OWNER
Credential: NP
Phone: 912-550-7091