Provider Demographics
NPI:1790183523
Name:CARTER, BYRON LAGARY (DA, NP-C)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:LAGARY
Last Name:CARTER
Suffix:
Gender:M
Credentials:DA, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-2153
Mailing Address - Country:US
Mailing Address - Phone:229-834-7738
Mailing Address - Fax:229-333-5959
Practice Address - Street 1:205 WOODROW WILSON DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2538
Practice Address - Country:US
Practice Address - Phone:229-245-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187228363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology