Healthcare Provider Details

I. General information

NPI: 1649278219
Provider Name (Legal Business Name): JOHN PAUL CARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 J DEWEY GRAY CIR SUITE 308
AUGUSTA GA
30909-6584
US

IV. Provider business mailing address

3624 J DEWEY GRAY CIR SUITE 308
AUGUSTA GA
30909-6584
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-5650
  • Fax: 706-863-0821
Mailing address:
  • Phone: 706-855-5650
  • Fax: 706-863-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15655
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: