MEDICARE: DEBORAH ELIZABETH CARPENTER MS, RN, WHCNP

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	363LW0102X	Women's Health Nurse Practitioner	RN095425	GA
2	363LW0102X	Women's Health Nurse Practitioner	CAR1-0429-5727	GA

General Provider Information

NPI Number	:	1659479376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ELIZABETH CARPENTER MS, RN, WHCNP

Provider Business Mailing Address
First Line	:	6415 HAMPTON CREEK DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-4031
Country	:	US
Telephone Number	:	404-754-1068
Fax Number	:	470-297-8032

Provider Business Practice Location Address
First Line	:	1628 MARKET PLACE BLVD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7927
Country	:	US
Telephone Number	:	404-754-1068
Fax Number	:	470-297-8032

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/02/2017

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