Healthcare Provider Details

I. General information

NPI: 1033036579
Provider Name (Legal Business Name): ACE CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11807 YATES FORD RD
FAIRFAX STATION VA
22039-1505
US

IV. Provider business mailing address

11807 YATES FORD RD
FAIRFAX STATION VA
22039-1505
US

V. Phone/Fax

Practice location:
  • Phone: 571-598-8418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: