Healthcare Provider Details

I. General information

NPI: 1457353658
Provider Name (Legal Business Name): JOHN A CARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E SUNFLOWER RD STE 100A
CLEVELAND MS
38732-2828
US

IV. Provider business mailing address

5943 STADIUM DR STE 1
KALAMAZOO MI
49009-3016
US

V. Phone/Fax

Practice location:
  • Phone: 662-579-0118
  • Fax: 662-846-5464
Mailing address:
  • Phone: 269-552-2836
  • Fax: 269-552-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301067523
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35897
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35897
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number4301067523
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036106764
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: