MEDICARE: DR. JEB S CARTER PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	26570	NC

General Provider Information

NPI Number	:	1194311589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEB S CARTER PHARMD.

Provider Business Mailing Address
First Line	:	5179 CLINTON RD
Second Line	:
City	:	STEDMAN
State	:	NC
Zip	:	28391-9516
Country	:	US
Telephone Number	:	910-483-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	5179 CLINTON RD
Second Line	:
City	:	STEDMAN
State	:	NC
Zip	:	28391-9516
Country	:	US
Telephone Number	:	910-483-9482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2020
Last Update Date	:	12/19/2020

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