Healthcare Provider Details

I. General information

NPI: 1669329637
Provider Name (Legal Business Name): THOMAS CARTER RDMS, RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3967 LANE AVE S
JACKSONVILLE FL
32210-4809
US

IV. Provider business mailing address

3967 LANE AVE S
JACKSONVILLE FL
32210-4809
US

V. Phone/Fax

Practice location:
  • Phone: 404-465-4881
  • Fax:
Mailing address:
  • Phone: 404-465-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: