1356301956 NPI number — DR. DENISE W CARTER OD

Table of content: DR. DENISE W CARTER OD (NPI 1356301956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356301956 NPI number — DR. DENISE W CARTER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
DENISE
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

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:
1356301956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUNGATE MEDICAL GROUP LLC
Provider Second Line Business Mailing Address:
10 WILLIAM POPE DRIVE
Provider Business Mailing Address City Name:
BLUFFTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29909-7549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-842-2020
Provider Business Mailing Address Fax Number:
843-705-1512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 KEMMERLIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LADYS ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29907-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-521-2020
Provider Business Practice Location Address Fax Number:
843-524-7559
Provider Enumeration Date:
03/27/2006

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: 152W00000X , with the licence number:  SC 1022 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D10227 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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