Provider Demographics
NPI:1336617323
Name:HUGHES, CARTER (ATC)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 BENT WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1513
Mailing Address - Country:US
Mailing Address - Phone:404-368-6905
Mailing Address - Fax:
Practice Address - Street 1:5505 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1985
Practice Address - Country:US
Practice Address - Phone:404-480-9330
Practice Address - Fax:404-480-4233
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT7672255A2300X
GAAT0035692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer