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General NPI Number Information
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NPI Number | 1326649351
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Entity Type | Individual
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Provider Name | OUIDA DEEDRA CARR
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 2389 WESLEY CHAPEL RD STE 102
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City | DECATUR
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State | GA
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Zip | 30035-2819
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Country | US
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Telephone | 404-044-6998
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Fax | 877-889-5105
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Provider Business Mailing Address
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Address Line | 2389 WESLEY CHAPEL RD STE 102
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City | DECATUR
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State | GA
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Zip | 30035-2819
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Country | US
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Telephone | 404-469-9867
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Fax | 877-889-5105
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN149253
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License Number State | GA
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