Healthcare Provider Details

I. General information

NPI: 1629207576
Provider Name (Legal Business Name): NATHAN MARCELLOUS CARTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILLINGSLEY RD
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-358-2700
  • Fax: 704-358-2716
Mailing address:
  • Phone: 704-358-2700
  • Fax: 704-358-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberP3697
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberNC-2010-01618
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2010-01618
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: