MEDICARE: GEORGE CARPENTER III M.D.

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	207P00000X	Emergency Medicine Physician	35070317	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00346010	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4126388	OTHER	TN	BCBS PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487632857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE CARPENTER III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3490
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-3490
Country	:	US
Telephone Number	:	931-647-5034
Fax Number	:	931-552-6663

Provider Business Practice Location Address
First Line	:	4220 HARDING RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2005
Country	:	US
Telephone Number	:	615-222-6733
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	01/23/2008

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