Provider Demographics
NPI:1316409139
Name:CARTER, MARY AUGUSTA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AUGUSTA
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 FOREST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4933
Mailing Address - Country:US
Mailing Address - Phone:804-282-9479
Mailing Address - Fax:804-282-9619
Practice Address - Street 1:7601 FOREST AVE STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4933
Practice Address - Country:US
Practice Address - Phone:804-282-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001252257163W00000X
VA0024181226363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse