1962452250 NPI number — DAVID E CARNEY MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962452250 NPI number — DAVID E CARNEY MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CARNEY

Provider First Name:

DAVID

Provider Middle Name:

E

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1962452250

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/04/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4750 WATERS AVE STE 307

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAVANNAH

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

31404-6268

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

912-350-7914

Provider Business Mailing Address Fax Number:

912-350-7973

Provider First Line Business Practice Location Address:

4750 WATERS AVE

Provider Second Line Business Practice Location Address:

SUITE 307

Provider Business Practice Location Address City Name:

SAVANNAH

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

31404-6200

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

912-350-7914

Provider Business Practice Location Address Fax Number:

912-350-7973

Provider Enumeration Date:

05/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2086S0120X , with the licence number:  058399 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: GPA748 . This is a "GROUP ID SC MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: P00386142 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 10067411 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 52205984-001 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: CH5121 . This is a "RR MEDICARE GROUP PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 362713 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 7703560 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 944905479A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: GRP3905 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 00002425248 07 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 9342322 . This is a "MULTIPLAN/PHCS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: G58399 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".