Provider Demographics
NPI:1518956408
Name:CARTER, ROBERT MICHAEL (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:CARTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GILLETTE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-4350
Mailing Address - Country:US
Mailing Address - Phone:912-673-9606
Mailing Address - Fax:
Practice Address - Street 1:C/148TH SB, 48TH BCT, 3RD ID
Practice Address - Street 2:
Practice Address - City:CAMP STRIKER
Practice Address - State:APO AE
Practice Address - Zip Code:09372
Practice Address - Country:IQ
Practice Address - Phone:302-646-1111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN-138459163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN-138459OtherLICENSE