Individual provider Active NPI

Kisha Nicole Carter, D.M.D.

  • General Practice Dentistry
  • East Point, GA
National Provider Identifier
1306004288
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN013722 Issued in GA
Practice address
1203 Cleveland Ave Ste 1a
East Point, GA 30344-3417
Phone
(404) 595-5104
Fax
(404) 601-7777
NPI assigned
May 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN013722 GA Primary

Addresses

Primary practice location

1203 Cleveland Ave Ste 1a
East Point, GA 30344-3417

Mailing address

1203 Cleveland Ave Ste 1a
East Point, GA 30344-3417
Phone (404) 595-5104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN013722GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kisha Carter DMD PC General Practice Current Accepting new patients

Locations

1203 Cleveland Ave
Ste 1A
East Point, GA 30344
Phone (404) 209-1408

854 Cleveland Ave
Ste 200
East Point, GA 30344

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1306004288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 CLEVELAND AVE STE 1A",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443417",
            "telephone_number": "404-595-5104",
            "fax_number": "404-601-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 CLEVELAND AVE STE 1A",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443417",
            "telephone_number": "404-595-5104",
            "fax_number": "404-601-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "KISHA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-28",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Point, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.