Provider Demographics
NPI:1245822154
Name:CARTER, MICHAEL TIMOTHY II
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:CARTER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 N FORK RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1846
Mailing Address - Country:US
Mailing Address - Phone:276-732-1986
Mailing Address - Fax:
Practice Address - Street 1:880 N FORK RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1846
Practice Address - Country:US
Practice Address - Phone:276-732-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705147295171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications