Individual
CHARLES JACKIE CARPENTER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4300 W MAIN ST STE 21, DOTHAN, AL 36305-1058
(334) 793-9564
(334) 671-8907
Mailing address
PO BOX 6599, DOTHAN, AL 36302-6599
(334) 699-7900
(334) 699-7901
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
17706
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000032574
—
AL
05
—
00801743A
—
GA
01
—
1073508404
NPI
—
Enumeration date
09/12/2005
Last updated
03/03/2021
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