Provider Demographics
NPI:1811797087
Name:CARTER, ROLANDA NICOLE
Entity type:Individual
Prefix:
First Name:ROLANDA
Middle Name:NICOLE
Last Name:CARTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ROLANDA
Other - Middle Name:NICOLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3951 FOXRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6029
Mailing Address - Country:US
Mailing Address - Phone:229-561-1189
Mailing Address - Fax:
Practice Address - Street 1:3951 FOXRIDGE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6029
Practice Address - Country:US
Practice Address - Phone:229-561-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor