Provider Demographics
NPI:1497862668
Name:CARTER, RODNEY G (MD)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:G
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RODNEY
Other - Middle Name:G
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:190 COMMUNITY CENTER DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-6251
Mailing Address - Country:US
Mailing Address - Phone:865-446-4032
Mailing Address - Fax:865-868-4746
Practice Address - Street 1:190 COMMUNITY CENTER DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6251
Practice Address - Country:US
Practice Address - Phone:865-446-4032
Practice Address - Fax:865-868-4746
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30020207Q00000X
TN30020208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3079526OtherBLUE CROSS BLUE SHIELD
TN3378953Medicaid
TN3822589Medicare ID - Type UnspecifiedDR. CARTER AS INDIVIDUAL
TN3378953Medicaid
TN3378953Medicare PIN