Healthcare Provider Details

I. General information

NPI: 1205467388
Provider Name (Legal Business Name): CARTER'S SPECIALTY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 GARRETT PINES DR
MIDLAND GA
31820-4365
US

IV. Provider business mailing address

8003 GARRETT PINES DR
MIDLAND GA
31820-4365
US

V. Phone/Fax

Practice location:
  • Phone: 810-394-8497
  • Fax:
Mailing address:
  • Phone: 810-394-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JANICE R CARTER
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 810-394-8497