Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 10683 | MS |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 10683 | MS |
NPI | 1093887945 |
---|---|
Provider Name | Dr. Gary Dwain Carr |
First Address | Hattiesburg, MS 39402-1267 |
Second Address | Southaven, MS 38672-7312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 06/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00017378 | (05) | MS |
C69998 | (02) |