Provider Demographics
NPI:1306824677
Name:CARR, GLORIA (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-4424
Mailing Address - Country:US
Mailing Address - Phone:334-263-2301
Mailing Address - Fax:334-263-0881
Practice Address - Street 1:3060 MOBILE HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36108-4027
Practice Address - Country:US
Practice Address - Phone:334-293-6670
Practice Address - Fax:334-293-6676
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-038999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517284OtherBCBS
AL630902068Medicaid
ALQ45129Medicare UPIN
AL630902068Medicaid