Provider Demographics
NPI:1609806439
Name:CARTY, CALPHOR S (MD)
Entity Type:Individual
Prefix:DR
First Name:CALPHOR
Middle Name:S
Last Name:CARTY
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 1:375 TARA LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-2107
Mailing Address - Country:US
Mailing Address - Phone:731-415-6683
Mailing Address - Fax:
Practice Address - Street 1:375 TARA LN
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-2107
Practice Address - Country:US
Practice Address - Phone:731-415-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN038761208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3896411Medicaid
TN3896411Medicaid
TN3896411Medicare PIN