Provider Demographics
NPI:1699327791
Name:CARTER, MARIA HICKS (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:HICKS
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 RIVERSIDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1395
Mailing Address - Country:US
Mailing Address - Phone:478-474-2114
Mailing Address - Fax:478-474-8001
Practice Address - Street 1:3400 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2513
Practice Address - Country:US
Practice Address - Phone:478-474-5600
Practice Address - Fax:478-471-6769
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily