Healthcare Provider Details

I. General information

NPI: 1184945925
Provider Name (Legal Business Name): NILES EDEMEKA CARTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NILES EDEMEKA ITA MD

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S. RIBAUT RD
PORT ROYAL SC
29936
US

IV. Provider business mailing address

395 WESTFIELD RD
NOBLESVILLE IN
46060-1434
US

V. Phone/Fax

Practice location:
  • Phone: 843-322-1800
  • Fax: 843-986-0229
Mailing address:
  • Phone: 317-773-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01079362A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37500
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: