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NPI Code Detail

MEDICARE: TYRIANNA TANE CARTER CAA

MEDICARE: TYRIANNA TANE CARTER CAA
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
1367H00000XAnesthesiologist Assistant13624GA

General Provider Information

NPI Number : 1750275582
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRIANNA TANE CARTER CAA
Provider Business Mailing Address
First Line : 1000 MEDICAL CENTER BLVD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30046-7694
Country : US
Telephone Number : 678-312-1000
Fax Number : 678-312-3282
Provider Business Practice Location Address
First Line : 3625 N HALL ST STE 800
Second Line :
City : DALLAS
State : TX
Zip : 75219-5106
Country : US
Telephone Number : 214-252-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2025
Last Update Date : 12/07/2025

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Directions to “ TYRIANNA TANE CARTER CAA” Practice Location

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