Provider Demographics
NPI:1316525306
Name:MCCARTER, IMANI DARA DAYO
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:DARA DAYO
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GILBREATH DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-2827
Mailing Address - Country:US
Mailing Address - Phone:205-274-8198
Mailing Address - Fax:205-274-8197
Practice Address - Street 1:150 GILBREATH DR STE 201
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2827
Practice Address - Country:US
Practice Address - Phone:205-274-8198
Practice Address - Fax:205-274-8197
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.3595207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine