Provider Demographics
NPI:1821583329
Name:CARTER, JOHN JOYCE IV (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOYCE
Last Name:CARTER
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-1138
Mailing Address - Country:US
Mailing Address - Phone:540-688-2646
Mailing Address - Fax:540-688-2656
Practice Address - Street 1:25 MYERS CORNER DR
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-6342
Practice Address - Country:US
Practice Address - Phone:540-688-2646
Practice Address - Fax:540-688-2656
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110006220OtherCOMMONWEALTH OF VA DEPT OF HEALTH PROFESSIONS STATE LICENSE