Individual
MR. GRADY GERALD CARTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 WHETSTONE PL STE 102, ST AUGUSTINE, FL 32086-5775
(904) 342-8300
Mailing address
3853 ASHGLEN DR E, JACKSONVILLE, FL 32224-7637
(904) 930-5056
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9113401
FL
Other
Enumeration date
04/21/2020
Last updated
08/22/2022
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