Healthcare Provider Details

I. General information

NPI: 1679079537
Provider Name (Legal Business Name): CARTER CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 1ST AVE NW STE 215
HICKORY NC
28601-6161
US

IV. Provider business mailing address

6026 SIX FORKS RD
RALEIGH NC
27609-3899
US

V. Phone/Fax

Practice location:
  • Phone: 919-423-0267
  • Fax:
Mailing address:
  • Phone: 919-848-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MYLEME OJINA HARRISON
Title or Position: CEO
Credential: MD
Phone: 919-848-0132