Healthcare Provider Details

I. General information

NPI: 1104747674
Provider Name (Legal Business Name): MR. GEORGE HENRY CARTER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 SUMMERFIELD DR STE A6-B
STOCKTON CA
95209-1196
US

IV. Provider business mailing address

2703 SUMMERFIELD DR
STOCKTON CA
95209-1196
US

V. Phone/Fax

Practice location:
  • Phone: 209-888-9634
  • Fax:
Mailing address:
  • Phone: 209-888-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: