Healthcare Provider Details

I. General information

NPI: 1750107942
Provider Name (Legal Business Name): JAMES CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 SARVIS FORK RD
SANDYVILLE WV
25275-7699
US

IV. Provider business mailing address

1273 SARVIS FORK RD
SANDYVILLE WV
25275-7699
US

V. Phone/Fax

Practice location:
  • Phone: 304-532-3015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: