Provider Demographics
NPI:1821178179
Name:CARTER, M. GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:GARY
Last Name:CARTER
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 1:1867 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1166
Mailing Address - Country:US
Mailing Address - Phone:478-745-2867
Mailing Address - Fax:478-746-5749
Practice Address - Street 1:1867 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1166
Practice Address - Country:US
Practice Address - Phone:478-745-2867
Practice Address - Fax:478-746-5749
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012434207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00135352CMedicaid
GA00135352CMedicaid