Provider Demographics
NPI:1891754529
Name:CARTER, STEVEN RAY (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:CARTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:175 GLENGARRY CHASE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-8919
Mailing Address - Country:US
Mailing Address - Phone:770-784-0761
Mailing Address - Fax:
Practice Address - Street 1:3160 ELM ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2461
Practice Address - Country:US
Practice Address - Phone:770-786-0070
Practice Address - Fax:770-786-9744
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000747213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480023108OtherRAILROAD MEDICARE
GA52616793004OtherBLUE CROSS HMO MADISON OFFICE
GA2716001OtherUNITED HEALTHCARE
GA000746611AMedicaid
GA000747OtherCHAMPUS
GA000747OtherCHAMPUS
GAU59111Medicare UPIN
GA0947480001Medicare NSC