Provider Demographics
NPI:1205186780
Name:CARTER B INVESTMENT INC DBA FUQUA MEDICAL GROUP
Entity Type:Organization
Organization Name:CARTER B INVESTMENT INC DBA FUQUA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:281-484-3844
Mailing Address - Street 1:2525 S VOSS RD
Mailing Address - Street 2:APT 364
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4434
Mailing Address - Country:US
Mailing Address - Phone:281-484-3844
Mailing Address - Fax:
Practice Address - Street 1:12559 GULF FREEWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4509
Practice Address - Country:US
Practice Address - Phone:281-484-3844
Practice Address - Fax:281-484-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687034313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX687034OtherTEXAS BOARD OF NURSING