Provider Demographics
NPI:1679671036
Name:CARTER, GEOFFREY KEITH (MA, AT,C)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:KEITH
Last Name:CARTER
Suffix:
Gender:M
Credentials:MA, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LAZY WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-9776
Mailing Address - Country:US
Mailing Address - Phone:864-332-1769
Mailing Address - Fax:
Practice Address - Street 1:109 FLEETWOOD DR STE E
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2019
Practice Address - Country:US
Practice Address - Phone:864-855-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer