Provider Demographics
NPI:1194774802
Name:CARTER, LEE MARVIN (M D)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:MARVIN
Last Name:CARTER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 RB WILSON DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-1733
Mailing Address - Country:US
Mailing Address - Phone:731-986-7305
Mailing Address - Fax:731-986-7254
Practice Address - Street 1:641 RB WILSON DR
Practice Address - Street 2:SUITE F
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1733
Practice Address - Country:US
Practice Address - Phone:731-986-7305
Practice Address - Fax:731-986-7254
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN023858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF45817Medicare UPIN
TN3072105Medicare ID - Type Unspecified