Individual provider Active NPI

Andrea Marie Maxwell

  • Nurse Practitioner
  • Carrollton, GA
National Provider Identifier
1508043191
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN161634 Issued in GA
Practice address
150 Clinic Ave
Suite 101
Carrollton, GA 30117-4401
Phone
(770) 834-0873
NPI assigned
Jan 25, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN161634 GA Primary

Addresses

Primary practice location

150 Clinic Ave
Suite 101
Carrollton, GA 30117-4401

Mailing address

150 Clinic Ave
Suite 101
Carrollton, GA 30117-4401

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080715000053 GA Practitioner - Nurse Practitioner 4486727146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carrollton Orthopaedic Clinic PCGroup PAC ID 7810989183, 31 clinicians

Practice addresses (Care Compare)

150 Clinic Ave
Carrollton, GA 30117-4498
Phone (770) 834-0873

150 Clinic Ave
Suite 101
Carrollton, GA 30117-4401

150 Clinic Ave
Suite 101
Carrollton, GA 30117-4402

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN161634GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carrollton Orthopaedic Clinic PC CurrentSince Apr 16, 2008 Accepting new patients

Locations

150 Clinic Ave
Carrollton, GA 30117
Phone (770) 834-0873

150 Clinic Ave
Ste 101
Carrollton, GA 30117
Phone (770) 834-0873

812 S Park St
Ste 3
Carrollton, GA 30117
Phone (770) 241-9255

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": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201219200000",
    "number": "1508043191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE",
            "address_2": "SUITE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE",
            "address_2": "SUITE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174401",
            "telephone_number": "770-834-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "ANDREA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-25",
        "last_updated": "2008-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN161634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.