MEDICARE: AMBER CARTER

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	183700000X	Pharmacy Technician	PHC037009	GA

General Provider Information

NPI Number	:	1750824975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER CARTER

Provider Business Mailing Address
First Line	:	220 RETREAT VLG
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-2403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 RETREAT VLG
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-2403
Country	:	US
Telephone Number	:	912-634-4817
Fax Number	:

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

Provider Enumeration Date	:	11/19/2016
Last Update Date	:	11/19/2016

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Directions to “ AMBER CARTER ” Practice Location

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