MEDICARE: MS. CHERVEKA CARTER-LOCKHART PP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	050663186	GA

General Provider Information

NPI Number	:	1194284208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERVEKA CARTER-LOCKHART PP

Provider Business Mailing Address
First Line	:	2522 NORRIS RD APT 4
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2573
Country	:	US
Telephone Number	:	706-888-6558
Fax Number	:	706-984-7334

Provider Business Practice Location Address
First Line	:	2522 NORRIS RD APT 4
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2573
Country	:	US
Telephone Number	:	706-888-6558
Fax Number	:	706-984-7334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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