Healthcare Provider Details

I. General information

NPI: 1265432884
Provider Name (Legal Business Name): TRACIE NAJOLIA CARTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 ROBERT BLVD STE 330
SLIDELL LA
70458-2006
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121
US

V. Phone/Fax

Practice location:
  • Phone: 985-280-7337
  • Fax: 985-280-7340
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD024141
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: