MEDICARE: DR. KISHA NICOLE CARTER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN013722	GA

General Provider Information

NPI Number	:	1306004288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KISHA NICOLE CARTER D.M.D.

Provider Business Mailing Address
First Line	:	1203 CLEVELAND AVE STE 1A
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	404-595-5104
Fax Number	:	404-601-7777

Provider Business Practice Location Address
First Line	:	1203 CLEVELAND AVE STE 1A
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	404-595-5104
Fax Number	:	404-601-7777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	02/05/2025

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