MEDICARE: DR. JAMES LENNART CARLSON MD

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	207Q00000X	Family Medicine Physician	200200010	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366545642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LENNART CARLSON MD

Provider Business Mailing Address
First Line	:	510 KINGSWORTH LN SE
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-8582
Country	:	US
Telephone Number	:	910-383-2226
Fax Number	:	910-654-1258

Provider Business Practice Location Address
First Line	:	7490 ANDREW JACKSON HWY.SW
Second Line	:
City	:	CERRO GORDO
State	:	NC
Zip	:	28430
Country	:	US
Telephone Number	:	910-654-2050
Fax Number	:	910-654-1258

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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