Provider Demographics
NPI:1669657128
Name:CARR, AMINIFU SADIFU (PA)
Entity Type:Individual
Prefix:MS
First Name:AMINIFU
Middle Name:SADIFU
Last Name:CARR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:AMINIFU
Other - Middle Name:CHRISTYL
Other - Last Name:SADIFU CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4990 WYNFORD LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-8012
Mailing Address - Country:US
Mailing Address - Phone:650-269-2259
Mailing Address - Fax:
Practice Address - Street 1:4990 WYNFORD LN
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-8012
Practice Address - Country:US
Practice Address - Phone:650-269-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12155363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical