Provider Demographics
NPI:1306931811
Name:CARTER, JUDY CHASTAIN (CN M)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:CHASTAIN
Last Name:CARTER
Suffix:
Gender:F
Credentials:CN M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 IVY CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056
Mailing Address - Country:US
Mailing Address - Phone:704-868-9050
Mailing Address - Fax:
Practice Address - Street 1:911 W. HUDSON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056
Practice Address - Country:US
Practice Address - Phone:704-853-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC147367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife