Provider Demographics
NPI:1104890276
Name:CARTER, ANTHONY CRAIG (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CRAIG
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-1128
Mailing Address - Country:US
Mailing Address - Phone:270-407-5150
Mailing Address - Fax:270-407-5153
Practice Address - Street 1:604 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1128
Practice Address - Country:US
Practice Address - Phone:270-407-5150
Practice Address - Fax:270-407-5153
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23371207R00000X
TN0000035137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4181459Medicaid
KS000000815201OtherANTHEM
KY64233711Medicaid
KY1440501Medicare PIN
TN4181459Medicaid
TN3867325OtherCIGNA MEDICARE
TN64203OtherBCBS