Individual
DUSTIN J CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
200 MAPLE DR, VIDALIA, GA 30474-8907
(912) 537-9851
(912) 537-9843
Mailing address
200 MAPLE DR, VIDALIA, GA 30474-8907
(912) 537-9851
(912) 537-9843
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003872
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
581356947
PRACTICE FEDERAL TAX ID
GA
05
—
683347114A
—
GA
Enumeration date
08/31/2005
Last updated
03/09/2010
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