Provider Demographics
NPI:1467650721
Name:MCCARTER, JOHN MICHAEL (MD,)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MCCARTER
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9664
Mailing Address - Country:US
Mailing Address - Phone:601-497-9232
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5570
Practice Address - Fax:601-815-3487
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-1841207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL157365Medicaid
MSP00785190OtherRAILROAD MEDICARE PTAN#
MS302I939853OtherMEDICARE PTAN
MS01621574Medicaid
MSP00785190OtherRAILROAD MEDICARE PTAN#
AL157365Medicaid