Provider Demographics
NPI:1033317144
Name:JOHNNIE C. CARTER, MD
Entity Type:Organization
Organization Name:JOHNNIE C. CARTER, MD
Other - Org Name:ENGLEWOOD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-745-9715
Mailing Address - Street 1:135 NORTH MEADOW DRIVE
Mailing Address - Street 2:STE #A
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303
Mailing Address - Country:US
Mailing Address - Phone:423-745-9715
Mailing Address - Fax:423-745-2440
Practice Address - Street 1:135 NORTH MEADOW DRIVE
Practice Address - Street 2:STE #A
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303
Practice Address - Country:US
Practice Address - Phone:423-745-9715
Practice Address - Fax:423-745-2440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNNIE C CARTER, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19400207Q00000X
TNMD19400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP83035Medicare UPIN