MEDICARE: BYRON KEITH CARTER PAC

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	363A00000X	Physician Assistant	103809	NC

General Provider Information

NPI Number	:	1306816244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON KEITH CARTER PAC

Provider Business Mailing Address
First Line	:	PO BOX 936857
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-6857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 TRADD CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-6637
Country	:	US
Telephone Number	:	910-251-3766
Fax Number	:	910-251-3760

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/26/2021

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Directions to “ BYRON KEITH CARTER PAC” Practice Location

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