Carly Alicia Fuqua, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN240849 Issued in GA

Practice address

2000 Howard Farm Dr Ste 450
Cumming, GA 30041-6085

Phone

(404) 845-8200

NPI assigned

Oct 3, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

Practice roles

Locations

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.

• Northside Cardiovascular Professional Services, LLC

  • Cardiovascular Disease Physician
  • Roswell, GA
  • NPI 1518979921
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation

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

{
    "created_epoch": "1727913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1366260770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HOWARD FARM DR STE 450",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416085",
            "telephone_number": "404-845-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 HOWARD FARM DR STE 450",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416085",
            "telephone_number": "404-845-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUQUA",
        "first_name": "CARLY",
        "middle_name": "ALICIA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-03",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN240849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Grace Fukuzato, O.D.
• Katherine Ann Fulco, CNP
• Fuller Life Counseling & Wellness, LLC
• Kendall Alexandra Fuller
• Hannah Funderburk
• Peter R Futrell, M.D.
• Jeanne Therese Futscher, MS CCC-SLP
• Futures ABA Ga LLC
• Fyz 400 LLC
• Ga Art Medical Clinic PC

• Nurse Practitioner in Cumming, GA
• Providers in Cumming, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.