Healthcare Provider Details

I. General information

NPI: 1467867721
Provider Name (Legal Business Name): G.P. CARTER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N. LOCK AVE.
LOUISA KY
41230-1197
US

IV. Provider business mailing address

412 N. LOCK AVE.
LOUISA KY
41230-1197
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-4595
  • Fax: 606-638-4595
Mailing address:
  • Phone: 606-638-4595
  • Fax: 606-638-9471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: MARC A. WORKMAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 606-638-4595