Provider Demographics
NPI:1932280815
Name:CARTER, CLEO (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEO
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4821 MANASSAS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4747
Mailing Address - Country:US
Mailing Address - Phone:615-944-1726
Mailing Address - Fax:615-944-1726
Practice Address - Street 1:710 HART LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37243-2010
Practice Address - Country:US
Practice Address - Phone:615-650-7048
Practice Address - Fax:615-262-6139
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD015211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA10432Medicare UPIN
3029950Medicare PIN