Provider Demographics
NPI:1285634212
Name:CARTER, KELLI M (MD)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:M
Last Name:CARTER
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 1:3686 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909
Mailing Address - Country:US
Mailing Address - Phone:706-922-6300
Mailing Address - Fax:706-922-6303
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
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000716757FMedicaid
GA000716757NMedicaid
GA000716757FMedicaid
GA08BBXMMMedicare ID - Type Unspecified
GA202I081525Medicare PIN