Healthcare Provider Details

I. General information

NPI: 1083660104
Provider Name (Legal Business Name): RICHARD CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 KLONDIKE RD SW SUITE 106
CONYERS GA
30094-5169
US

IV. Provider business mailing address

1100 JOHNSON FERRY RD NE SUITE 510
SANDY SPRINGS GA
30342-1709
US

V. Phone/Fax

Practice location:
  • Phone: 770-761-7260
  • Fax: 678-413-1818
Mailing address:
  • Phone: 404-419-1140
  • Fax: 404-419-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number038439
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: