Provider Demographics
NPI:1821185430
Name:CARR, JAMES BRADLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRADLEY
Last Name:CARR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 DEERWOOD TRL STE C
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-8872
Mailing Address - Country:US
Mailing Address - Phone:601-953-0333
Mailing Address - Fax:
Practice Address - Street 1:310 BYRAM PLACE
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39272-9258
Practice Address - Country:US
Practice Address - Phone:601-373-1351
Practice Address - Fax:601-372-7029
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4417-231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice