Provider Demographics
NPI:1285334052
Name:CARTER, ANTWAN
Entity type:Individual
Prefix:MR
First Name:ANTWAN
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-5523
Mailing Address - Country:US
Mailing Address - Phone:312-684-6020
Mailing Address - Fax:
Practice Address - Street 1:1067 JOHNSON LN
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-5523
Practice Address - Country:US
Practice Address - Phone:312-684-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347E00000XTransportation ServicesTransportation Broker
No374700000XNursing Service Related ProvidersTechnician