Healthcare Provider Details

I. General information

NPI: 1649477191
Provider Name (Legal Business Name): ROBERT L. CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S CHURCH ST
CHARLESTON MS
38921-2257
US

IV. Provider business mailing address

PO BOX 71807
RICHMOND VA
23255-1807
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-5816
  • Fax: 662-647-5705
Mailing address:
  • Phone: 804-350-2889
  • Fax: 804-612-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19835
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19835
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: