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General NPI Number Information
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NPI Number | 1104173798
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Entity Type | Organization
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Legal Business Name | JAMES E CARTER, IV, DMD, PC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 4520 NELSON BROGDON BLVD
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City | BUFORD
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State | GA
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Zip | 30518-3478
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Country | US
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Telephone | 770-945-2119
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Fax | 770-945-0979
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Provider Business Mailing Address
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Address Line | 4520 NELSON BROGDON BLVD
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City | BUFORD
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State | GA
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Zip | 30518-3478
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Country | US
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Telephone | 770-945-2119
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Fax | 770-945-0979
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RENEE E WALKER
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Credential |
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Telephone | 770-945-2119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN010592
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License Number State | GA
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