Provider Demographics
NPI:1912991670
Name:CARTER, JASON B (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1404 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4395
Mailing Address - Country:US
Mailing Address - Phone:423-638-4046
Mailing Address - Fax:423-638-4295
Practice Address - Street 1:1404 TUSCULUM BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4395
Practice Address - Country:US
Practice Address - Phone:423-638-4046
Practice Address - Fax:423-638-4295
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN40756208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734711Medicaid
TN4129940OtherBCBSTN
TN912945OtherCIGNA
TN7267809OtherAETNA
TN4129940OtherBCBSTN
H78718Medicare UPIN