Individual provider Active NPI

Mark Douglas Carter

  • Physical Therapy Assistant
  • Snellville, GA
National Provider Identifier
1780168674
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA003787 Issued in GA
Practice address
2346 Wisteria Dr Ste 110
Snellville, GA 30078-6174
Phone
(678) 701-2225
NPI assigned
Sep 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA003787 GA Primary

Addresses

Primary practice location

2346 Wisteria Dr Ste 110
Snellville, GA 30078-6174

Mailing address

170 Forrest Lake Rd
Alpharetta, GA 30022-1009
Phone (678) 910-8533

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

State licenses

LicenseStateTypeSpecialty
PTA003787GAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aica Orthopedics, P. C. Past Accepting new patients
Aica Orthopedics, P.C. Past Accepting new patients
Aica Orthopedics, P. C. Past Accepting new patients
Aica Orthopedics, P.C. Past Accepting new patients
Aica Orthopedics, P.C. Past Accepting new patients

Organizations & group practices 5

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": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1780168674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 FORREST LAKE RD",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300221009",
            "telephone_number": "678-910-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2346 WISTERIA DR STE 110",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300786174",
            "telephone_number": "678-701-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "MARK",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA003787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.