Provider Demographics
NPI:1134323355
Name:CARTER, CORNELIUS JEMEEL (CERTIFIED TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:JEMEEL
Last Name:CARTER
Suffix:
Gender:M
Credentials:CERTIFIED TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 720483
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070
Mailing Address - Country:US
Mailing Address - Phone:405-360-2454
Mailing Address - Fax:405-360-8650
Practice Address - Street 1:117 WILLOW BRANCH RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4506
Practice Address - Country:US
Practice Address - Phone:405-360-2454
Practice Address - Fax:405-360-8650
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist