Provider Demographics
NPI:1730110057
Name:CARLTON, FREDERICK BARNETT JR (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:BARNETT
Last Name:CARLTON
Suffix:JR
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:PO BOX 23457
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3457
Mailing Address - Country:US
Mailing Address - Phone:601-200-4749
Mailing Address - Fax:601-200-5929
Practice Address - Street 1:969 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4606
Practice Address - Country:US
Practice Address - Phone:601-200-2000
Practice Address - Fax:601-200-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09092207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0014321Medicaid
MS110063827OtherRAILROAD MEDICARE
MS512G700003OtherMS MEDICARE - GROUP
C48063Medicare UPIN
MS110063827OtherRAILROAD MEDICARE
MSC02387Medicare PIN
MS080000567Medicare ID - Type Unspecified