Active NPI
Nicole Dupraw Carter, M.D.
- Pediatrics Physician
- Lagrange, GA
National Provider Identifier
1336280114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 54982
- Practice address
- 301 Medical Dr Ste 504
Lagrange, GA 30240-4172 - Phone
- (706) 812-2655
- NPI assigned
- Feb 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 54982 | GA | Primary |
| Pediatrics Physician | 208000000X | 25967 | AL |
Addresses
Primary practice location
301 Medical Dr Ste 504
Lagrange, GA 30240-4172
Mailing address
301 Medical Dr Ste 504
Lagrange, GA 30240-4172
Phone (706) 812-2655
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37544 | Other | AMERICAN BOARD PEDIATRICS | |
| 009962415 | Medicaid | AL | |
| 926662 | Other | AAP ID | |
| 009962405 | Medicaid | AL | |
| 515-22781 | Other | AL | BCBS AL PROV # OPELIKA |
| 25967 | Other | AL | ALABAMA CONTR SUBST CERT |
| 515-22782 | Other | AL | BCBS AL PROV # AUBURN |
| 25967 | Other | AL | ALABAMA MEDICAL LICENSE |
| 54982 | Other | GA | GEORGIA MEDICAL LICENSE |
Other names 1
- Dr. Nicole Marie Dupraw
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25967 | AL | MD | Pediatrics Physician |
| 54982 | GA | MD | Pediatrics Physician |
Interoperability endpoints
- nicolecarter@pcllc.allscriptsdirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723852800000",
"number": "1336280114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 MEDICAL DR STE 504",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302404172",
"telephone_number": "706-812-2655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 MEDICAL DR STE 504",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302404172",
"telephone_number": "706-812-2655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARTER",
"first_name": "NICOLE",
"middle_name": "DUPRAW",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2024-08-17",
"certification_date": "2024-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "54982",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "25967",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN BOARD PEDIATRICS",
"identifier": "37544",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009962415",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AAP ID",
"identifier": "926662",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009962405",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS AL PROV # OPELIKA",
"identifier": "515-22781",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA CONTR SUBST CERT",
"identifier": "25967",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS AL PROV # AUBURN",
"identifier": "515-22782",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA MEDICAL LICENSE",
"identifier": "25967",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA MEDICAL LICENSE",
"identifier": "54982",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "DUPRAW",
"middle_name": "MARIE",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lagrange, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.