Provider Demographics
NPI:1619174091
Name:HARRISON C CARTER MD PC
Entity Type:Organization
Organization Name:HARRISON C CARTER MD PC
Other - Org Name:HARRISON CLAY CARTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-632-7300
Mailing Address - Street 1:1126 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-1814
Mailing Address - Country:US
Mailing Address - Phone:912-632-7300
Mailing Address - Fax:912-632-1326
Practice Address - Street 1:1126 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-1814
Practice Address - Country:US
Practice Address - Phone:912-632-7300
Practice Address - Fax:912-632-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050575174400000X
GARN106778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA3099OtherMEDICARE RAILROAD
GA000922908AMedicaid
GAH44895Medicare UPIN