Provider Demographics
NPI:1043221492
Name:CARTER, HARRISON CLAY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:CLAY
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-1814
Mailing Address - Country:US
Mailing Address - Phone:912-632-7300
Mailing Address - Fax:912-632-1326
Practice Address - Street 1:1126 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-1814
Practice Address - Country:US
Practice Address - Phone:912-632-7300
Practice Address - Fax:912-632-1326
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000922908BMedicaid
GA000922908AMedicaid
GA000922908BMedicaid