Healthcare Provider Details

I. General information

NPI: 1255441994
Provider Name (Legal Business Name): KAREN L. CARTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 D'ANTIGNAC STREET SUITE 2100
AUGUSTA GA
30901
US

IV. Provider business mailing address

1303 D'ANTIGNAC STREET SUITE 2100
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-396-0600
  • Fax: 706-396-0606
Mailing address:
  • Phone: 706-396-0600
  • Fax: 706-396-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number044184
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: