Provider Demographics
NPI:1184663866
Name:CARTER, ERIC JASON (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JASON
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1333 S DICKINSON DR UNIT 230
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6434
Practice Address - Country:US
Practice Address - Phone:910-662-6600
Practice Address - Fax:910-332-0246
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184663866Medicaid
NC2756619BMedicare PIN
NCNCN410AMedicare PIN
NC2756619AMedicare PIN
NC1184663866Medicaid
NC1022110001Medicare NSC
P18032Medicare UPIN