Healthcare Provider Details

I. General information

NPI: 1780681486
Provider Name (Legal Business Name): JOHN EVERETT CARTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JAMES RD
GRANBURY TX
76049-8207
US

IV. Provider business mailing address

PO BOX 2459
GRANBURY TX
76048-7459
US

V. Phone/Fax

Practice location:
  • Phone: 817-326-2727
  • Fax: 817-326-5737
Mailing address:
  • Phone: 817-326-2727
  • Fax: 817-326-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01396
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: