Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 005224 | TN |
NPI | 1497327019 |
---|---|
Provider Name | Louis Loraine Carter JR. |
First Address | Lookout Mountain, TN 37350-1424 |
Second Address | Lookout Mountain, TN 37350-1424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2021 |
Last Update Date | 13/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005224 | TENNESSEE STATE LICENSE (01) | TN |