Healthcare Provider Details

I. General information

NPI: 1760527766
Provider Name (Legal Business Name): JAMIE S CARPENTER R MR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 FAIRVIEW PARK DR # A
DUBLIN GA
31021-2501
US

IV. Provider business mailing address

2580 WOODFORD LN
BUFORD GA
30519-6119
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-8895
  • Fax: 478-275-8896
Mailing address:
  • Phone: 404-683-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number354922
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number354922
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: