Provider Demographics
NPI:1316999287
Name:CARR, BENJAMIN MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MATTHEW
Last Name:CARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4138
Mailing Address - Country:US
Mailing Address - Phone:256-543-0131
Mailing Address - Fax:256-543-0132
Practice Address - Street 1:740 FORREST AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3639
Practice Address - Country:US
Practice Address - Phone:256-543-0131
Practice Address - Fax:256-543-0132
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC279292084P0800X
AL287792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC279291Medicaid
SCI42549Medicare UPIN
SCAA10983353Medicare PIN