Provider Demographics
NPI:1144402652
Name:KELLI M CARTER MD LLC
Entity Type:Organization
Organization Name:KELLI M CARTER MD LLC
Other - Org Name:FAMILY FIRST HEALTHCARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-595-7825
Mailing Address - Street 1:1113 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-7523
Mailing Address - Country:US
Mailing Address - Phone:706-595-7825
Mailing Address - Fax:706-595-1235
Practice Address - Street 1:1113 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7523
Practice Address - Country:US
Practice Address - Phone:706-595-7825
Practice Address - Fax:706-595-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4983Medicare UPIN