Healthcare Provider Details

I. General information

NPI: 1164515888
Provider Name (Legal Business Name): JAMES CARTER IV DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RIVERSIDE PARKWAY SUITE 200
NORCROSS GA
30022
US

IV. Provider business mailing address

2000 NORLAND CIRCLE COURT
ALPHARETTA GA
30072
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2109
  • Fax: 770-441-0299
Mailing address:
  • Phone: 678-575-3756
  • Fax: 770-441-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number010592
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: