Healthcare Provider Details

I. General information

NPI: 1902675234
Provider Name (Legal Business Name): GEORGE CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE FERMAN JR.

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 PHOENIX DR STE 115
VIRGINIA BEACH VA
23452-7392
US

IV. Provider business mailing address

3535 ROBINSON RD
VIRGINIA BEACH VA
23456-4160
US

V. Phone/Fax

Practice location:
  • Phone: 757-621-4953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1038982
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: