Provider Demographics
NPI:1336280114
Name:CARTER, NICOLE DUPRAW (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DUPRAW
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:DUPRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 MEDICAL DR STE 504
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4172
Mailing Address - Country:US
Mailing Address - Phone:706-812-2655
Mailing Address - Fax:
Practice Address - Street 1:301 MEDICAL DR STE 504
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4172
Practice Address - Country:US
Practice Address - Phone:706-812-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54982208000000X
AL25967208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
37544OtherAMERICAN BOARD PEDIATRICS
AL009962415Medicaid
926662OtherAAP ID
AL009962405Medicaid
AL515-22781OtherBCBS AL PROV # OPELIKA
AL25967OtherALABAMA CONTR SUBST CERT
AL515-22782OtherBCBS AL PROV # AUBURN
AL25967OtherALABAMA MEDICAL LICENSE
GA54982OtherGEORGIA MEDICAL LICENSE