Provider Demographics
NPI:1508065269
Name:CARTER, RICHARD B JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:CARTER
Suffix:JR
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 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5279
Practice Address - Country:US
Practice Address - Phone:865-475-4742
Practice Address - Fax:865-262-0100
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37066301Medicaid
TN37066303OtherMEDICAID LEGACY GROUP
TN37066301OtherMEDICARE LEGACY GROUP
TN4132310OtherBCBS PIN
TN4132310OtherBCBS PIN