Healthcare Provider Details

I. General information

NPI: 1700348547
Provider Name (Legal Business Name): JOHN C CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RAWLS DR STE 1300
MCCOMB MS
39648-2866
US

IV. Provider business mailing address

PO BOX 511
LIBERTY MS
39645-0511
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-3541
  • Fax: 601-249-3544
Mailing address:
  • Phone: 601-657-4326
  • Fax: 601-657-4467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30331
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: