MEDICARE: CARTER CLINIC, P A

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1558847434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTER CLINIC, P A

Provider Business Mailing Address
First Line	:	6026 SIX FORKS RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-3899
Country	:	US
Telephone Number	:	919-848-0132
Fax Number	:	919-848-0277

Provider Business Practice Location Address
First Line	:	2409 N ELM ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3658
Country	:	US
Telephone Number	:	910-689-5333
Fax Number	:	910-703-8632

Authorized Official
Title or Position	:	CEO
Name	:	MYLEME OJINGA HARRISON
Credential	:
Telephone Number	:	919-848-0132

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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