1649279811 NPI number — MARK E CARVER MD

Table of content: MARK E CARVER MD (NPI 1649279811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649279811 NPI number — MARK E CARVER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARVER
Provider First Name:
MARK
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649279811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 535744
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30353-5510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-294-5114
Provider Business Mailing Address Fax Number:
865-691-0843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 W RAVINE RD
Provider Second Line Business Practice Location Address:
SUITE 5-B
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660-3847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-224-3460
Provider Business Practice Location Address Fax Number:
423-224-3465
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  21694 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3042034 . This is a "BS OF TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 281112 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P050053051 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100010714 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3804029 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0100 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00013859 . This is a "NHC CARE ADMIN." identifier . This identifiers is of the category "OTHER".
  • Identifier: 005706271 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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