Provider Demographics
NPI:1043210974
Name:CARTER-WICKER, KITTY B (MD)
Entity Type:Individual
Prefix:DR
First Name:KITTY
Middle Name:B
Last Name:CARTER-WICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PIEDMONT AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2544
Mailing Address - Country:US
Mailing Address - Phone:404-756-5764
Mailing Address - Fax:404-756-5252
Practice Address - Street 1:1513 CLEVELAND AVE BLDG 500
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6903
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000679907Medicaid
G17336Medicare UPIN
GA08BDJTWMedicare ID - Type Unspecified