Provider Demographics
NPI:1073226338
Name:CARTER, MATTHEW ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 VERDAE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4021
Mailing Address - Country:US
Mailing Address - Phone:864-516-1783
Mailing Address - Fax:864-516-1784
Practice Address - Street 1:1220 PARKSIDE ACORN DR
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-8344
Practice Address - Country:US
Practice Address - Phone:864-516-1783
Practice Address - Fax:864-516-1784
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
SC4746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical