Basic Information
Provider Information | |||||||||
NPI: | 1306846233 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HERBERT-CARTER | ||||||||
FirstName: | JANICE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 720 WESTVIEW DRIVE SW | ||||||||
Address2: | HARRIS BLDG., 100-A | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 30310 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4047561400 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1513 EAST CLEVELAND AVENUE | ||||||||
Address2: |   | ||||||||
City: | EAST POINT | ||||||||
State: | GA | ||||||||
PostalCode: | 30344 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4047521000 | ||||||||
FaxNumber: | 4047521191 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2005 | ||||||||
LastUpdateDate: | 09/25/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 033594 | GA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 000445739 | 05 | GA |   | MEDICAID |