Provider Demographics
NPI:1255441994
Name:CARTER, KAREN L (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 D'ANTIGNAC STREET
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-396-0600
Mailing Address - Fax:706-396-0606
Practice Address - Street 1:1303 D'ANTIGNAC STREET
Practice Address - Street 2:SUITE 2100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-396-0600
Practice Address - Fax:706-396-0606
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0441842080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG44184Medicaid
GA000897245AMedicaid
SCG44184Medicaid
GA37BBFXCMedicare ID - Type UnspecifiedGA MEDICARE #