Provider Demographics
NPI:1093887945
Name:CARR, GARY DWAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DWAIN
Last Name:CARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 METHODIST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1267
Mailing Address - Country:US
Mailing Address - Phone:601-296-3151
Mailing Address - Fax:
Practice Address - Street 1:6858 SWINNEA RD BLDG 7
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9493
Practice Address - Country:US
Practice Address - Phone:662-510-8400
Practice Address - Fax:662-510-8500
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10683207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017378Medicaid
MS00017378Medicaid
C69998Medicare UPIN