Provider Demographics
NPI:1528257078
Name:CARR, JOHN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:CARR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3470 YOUTH MONROE RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4327
Mailing Address - Country:US
Mailing Address - Phone:678-957-6301
Mailing Address - Fax:678-957-6303
Practice Address - Street 1:3470 YOUTH MONROE RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4327
Practice Address - Country:US
Practice Address - Phone:678-957-6301
Practice Address - Fax:678-957-6303
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA025952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDWKTMedicare PIN