Active NPI
Andrea Marie Maxwell
- Nurse Practitioner
- Carrollton, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN161634
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 PC
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
| License | State | Type | Specialty |
|---|---|---|---|
| RN161634 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carrollton Orthopaedic Clinic PC | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; 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.