Provider Demographics
NPI:1558458257
Name:CARTER, JOHNNIE C (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:C
Last Name:CARTER
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 1:135 NORTH MEADOW DRIVE
Mailing Address - Street 2:STE #A
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303
Mailing Address - Country:US
Mailing Address - Phone:423-745-9715
Mailing Address - Fax:423-745-2440
Practice Address - Street 1:135 NORTH MEADOW DRIVE
Practice Address - Street 2:STE #A
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303
Practice Address - Country:US
Practice Address - Phone:423-745-9715
Practice Address - Fax:423-745-2440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3046780Medicaid
TN93503OtherBC
TNC72080Medicare UPIN
TN3046780Medicare ID - Type Unspecified