Carpenter, Charles Jackie

Carpenter, Charles Jackie is an sole proprietor health care provider with primary practice located at 4300 W Main St Ste 21 , Dothan AL 36305-1058. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Carpenter, Charles Jackie can be contacted via phone (334) 793-9564.

Contact Information

Primary practice address
4300 W Main St Ste 21 Dothan AL 36305-1058
Phone: (334) 793-9564
Fax: (334) 671-8907
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 17706 Alabama

Profile Details

NPI number 1073508404
LBN Legal business name Carpenter, Charles Jackie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 12th, 2005
Last updated Mar 3rd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073508404 NPPES
Alabama MEDICAID 000032574
Alabama Other 1073508404
Alabama MEDICAID 00801743A

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