Provider Demographics
NPI:1619985785
Name:CARRICK, JANICE R (DO)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:R
Last Name:CARRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14826 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9447
Mailing Address - Country:US
Mailing Address - Phone:740-594-9181
Mailing Address - Fax:740-594-8042
Practice Address - Street 1:265 W UNION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2313
Practice Address - Country:US
Practice Address - Phone:740-594-9181
Practice Address - Fax:740-594-8042
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340042292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0712475Medicaid
OH0712475Medicaid
OH0805374Medicare ID - Type Unspecified