Healthcare Provider Details

I. General information

NPI: 1619174091
Provider Name (Legal Business Name): HARRISON C CARTER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W 12TH ST
ALMA GA
31510-1814
US

IV. Provider business mailing address

1126 W 12TH ST
ALMA GA
31510-1814
US

V. Phone/Fax

Practice location:
  • Phone: 912-632-7300
  • Fax: 912-632-1326
Mailing address:
  • Phone: 912-632-7300
  • Fax: 912-632-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number050575
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN106778
License Number StateGA

VIII. Authorized Official

Name: JOHNNIE CARTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-632-7300