MEDICARE: DR. MAYA JAMILAH CARTER MD

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	207Q00000X	Family Medicine Physician	036116034	IL
2	207Q00000X	Family Medicine Physician	059904	GA

General Provider Information

NPI Number	:	1457379711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYA JAMILAH CARTER MD

Provider Business Mailing Address
First Line	:	3355 CASCADE RD SW
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30311-3678
Country	:	US
Telephone Number	:	404-691-2529
Fax Number	:	404-691-2382

Provider Business Practice Location Address
First Line	:	3355 CASCADE RD SW
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30311-3678
Country	:	US
Telephone Number	:	404-691-2529
Fax Number	:	404-691-2382

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/01/2013

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