Provider Demographics
NPI:1316935786
Name:CARR, MICHAEL ROBIN V (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBIN
Last Name:CARR
Suffix:V
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W CHASON ST
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1284
Mailing Address - Country:US
Mailing Address - Phone:229-524-5772
Mailing Address - Fax:229-524-5900
Practice Address - Street 1:100 W CHASON ST
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1284
Practice Address - Country:US
Practice Address - Phone:229-524-5772
Practice Address - Fax:229-524-5900
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0089361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00167681AMedicaid