Individual
JULIE J CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3451 GOODMAN RD E STE 115, SOUTHAVEN, MS 38672-9304
(662) 890-5555
(662) 890-8899
Mailing address
1022 N GERMANTOWN PKWY, CORDOVA, TN 38018-5892
(901) 254-8500
(901) 754-8578
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17222
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00181717
MEDICARE RAILROAD
MS
Enumeration date
06/01/2005
Last updated
03/29/2019
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