Healthcare Provider Details

I. General information

NPI: 1518923861
Provider Name (Legal Business Name): JAMES MARK CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W C PL
RUSSELLVILLE AR
72801-2705
US

IV. Provider business mailing address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-7717
  • Fax: 866-280-8464
Mailing address:
  • Phone: 479-968-2345
  • Fax: 479-890-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-4070
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: