Healthcare Provider Details

I. General information

NPI: 1437149200
Provider Name (Legal Business Name): MICHAEL P CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 HWY 119 S
SPRINGFIELD GA
31329-3021
US

IV. Provider business mailing address

PO BOX 14416
SAVANNAH GA
31416-1416
US

V. Phone/Fax

Practice location:
  • Phone: 912-754-6451
  • Fax:
Mailing address:
  • Phone: 912-355-8188
  • Fax: 912-356-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number017014
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00179825A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier705348818A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 3
Identifier007211
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerBCBS
# 4
Identifier705348818B
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: