Provider Demographics
NPI:1699277384
Name:CARTER RN, MELODY RENEE (RN)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:RENEE
Last Name:CARTER RN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-1498
Mailing Address - Country:US
Mailing Address - Phone:229-415-1748
Mailing Address - Fax:
Practice Address - Street 1:514 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1498
Practice Address - Country:US
Practice Address - Phone:229-415-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089976163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty