Healthcare Provider Details

I. General information

NPI: 1619960531
Provider Name (Legal Business Name): CARTER TATE HOLBROOK III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

1826 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-329-7337
  • Fax: 252-329-1477
Mailing address:
  • Phone: 252-329-7337
  • Fax: 252-329-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20146
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: