Provider Demographics
NPI:1114085354
Name:CARR, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-0449
Mailing Address - Country:US
Mailing Address - Phone:910-488-4525
Mailing Address - Fax:910-448-4530
Practice Address - Street 1:2409 MURCHISON RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3519
Practice Address - Country:US
Practice Address - Phone:910-488-4525
Practice Address - Fax:910-488-4530
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891224RMedicaid
NC891224RMedicaid
G96874Medicare UPIN