Healthcare Provider Details

I. General information

NPI: 1194468579
Provider Name (Legal Business Name): ELLEN BERRY CARTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1793 CLIFF GOOKIN BLVD
TUPELO MS
38801-6723
US

IV. Provider business mailing address

1793 CLIFF GOOKIN BLVD
TUPELO MS
38801-6723
US

V. Phone/Fax

Practice location:
  • Phone: 662-842-1161
  • Fax: 662-842-6375
Mailing address:
  • Phone: 662-842-1161
  • Fax: 662-842-6375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37532
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: