Individual provider Active NPI

Carly Marie Singletary

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1649835638
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9874 Issued in GA
Practice address
1931 Harrison Park Dr
Atlanta, GA 30341-4844
Phone
(615) 445-0957
NPI assigned
May 5, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 9874 GA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1931 Harrison Park Dr
Atlanta, GA 30341-4844

Mailing address

1931 Harrison Park Dr
Atlanta, GA 30341-4844
Phone (615) 445-0957

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
I20210622001633 GA Practitioner - Physician Assistant 7810398344 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Mercer University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Georgia PCGroup PAC ID 6800885757, 56 clinicians

Practice addresses (Care Compare)

2870 Ronald Reagan Blvd
Suite 103
Cumming, GA 30041-6092
Phone (470) 242-0714

835 Cogburn Ave NW
Suite 100
Marietta, GA 30060-1008
Phone (770) 422-5557

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9874GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatopathology Lab of Skin Cancer Specialists, P.C. CurrentSince Apr 1, 2024 Accepting new patients

Locations

1255 Friendship Rd
Ste 120
Braselton, GA 30517
Phone (470) 201-7777

1839 Buford Hwy
Ste 100
Buford, GA 30518
Phone (678) 450-9933

470 Northside Cherokee Blvd
Ste 170
Canton, GA 30115
Phone (770) 721-9540

2870 Ronald Reagan Blvd
Ste 103
Cumming, GA 30041
Phone (248) 601-4900

2000 Howard Farm Dr
Ste 320
Cumming, GA 30041
Phone (404) 847-4180

5983 Highway 53 E
Ste 200
Dawsonville, GA 30534
Phone (770) 754-0787

835 Cogburn Ave NW
Ste 100
Marietta, GA 30060
Phone (770) 422-5557

1163 Johnson Ferry Rd
Ste 250
Marietta, GA 30068
Phone (770) 321-1001

1357 Hembree Rd
Ste 250
Roswell, GA 30076
Phone (770) 475-7550

4298 Atlanta Rd SE
Ste 320
Smyrna, GA 30080
Phone (470) 242-0717

2001 Professional Way
Ste 250
Woodstock, GA 30188
Phone (770) 754-0787

Interoperability endpoints

  • Direct secure messaging: csingletary@directaddress.net

Organizations & group practices 3

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": "1557014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1649835638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1931 HARRISON PARK DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414844",
            "telephone_number": "615-445-0957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1931 HARRISON PARK DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414844",
            "telephone_number": "615-445-0957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SINGLETARY",
        "first_name": "CARLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-05",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9874",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.