Provider Demographics
NPI:1538386370
Name:MARY LEE CARTER, MD-PC
Entity type:Organization
Organization Name:MARY LEE CARTER, MD-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-576-5999
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-0307
Mailing Address - Country:US
Mailing Address - Phone:912-576-5999
Mailing Address - Fax:912-576-5888
Practice Address - Street 1:308 BEDELL AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-0308
Practice Address - Country:US
Practice Address - Phone:912-576-5999
Practice Address - Fax:912-576-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI12924Medicare UPIN
GA11SCCZHMedicare ID - Type Unspecified