MEDICARE: DUSTIN J CARTER MPAS, PA-C

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	363AM0700X	Medical Physician Assistant	003872	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	581356947	OTHER	GA	PRACTICE FEDERAL TAX ID

General Provider Information

NPI Number	:	1982698361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN J CARTER MPAS, PA-C

Provider Business Mailing Address
First Line	:	200 MAPLE DR
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-8907
Country	:	US
Telephone Number	:	912-537-9851
Fax Number	:	912-537-9843

Provider Business Practice Location Address
First Line	:	200 MAPLE DR
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-8907
Country	:	US
Telephone Number	:	912-537-9851
Fax Number	:	912-537-9843

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/09/2010

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