Provider Demographics
NPI:1194908343
Name:CARR, DORIS LAURENE
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:LAURENE
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SCOTTIE
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:708 COURT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2153
Mailing Address - Country:US
Mailing Address - Phone:209-223-6750
Mailing Address - Fax:209-223-6478
Practice Address - Street 1:708 COURT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2153
Practice Address - Country:US
Practice Address - Phone:209-223-6750
Practice Address - Fax:209-223-6478
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator