CHARLES JACKIE CARPENTER JR. (NPI# 1073508404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073508404 |
| Entity Type | Individual |
| Full Name | CHARLES JACKIE CARPENTER JR. |
| Credential | MD |
| Practice Address |
4300 W Main St Ste 21 Dothan AL 36305-1058 |
| Practice Telephone | 3347939564 |
| Practice Fax Number | 3346718907 |
| Mailing Telephone | 3347939564 |
| Mailing Fax Number | 3346718907 |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2020-09-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 17706 | AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 000032574 | 05 | |
| GA | 00801743A | 05 | |
| NPI | 1073508404 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497085963 | Charles Keith Carpenter | Registered Nurse | 9900 Birch Run Rd Ste D, Birch Run, MI 48415-9609 | 2010-01-06 |
| 1326077728 | Charles Mark Carpenter | Dentist | 1086 Wyoming Ave, Forty Fort, PA 18704-4014 | 2006-06-30 |
| 1710306113 | Charles Carpenter | Health Educator | 15 Main St, Edison, NJ 08837-3447 | 2014-04-14 |
| 1457520462 | Charles Francis Carpenter | Preventive Medicine | 2131 Capitol Ave, Suite 300, Sacramento, CA 95816-5755 | 2008-02-23 |
| 1396969044 | Charles Mark Carpenter | Dentist | 1086 Wyoming Ave, Forty Fort, PA 18704-4014 | 2007-04-12 |
| 1265534101 | Charles Sheldon Carpenter | Psychologist | 610 E Grant Ave, Greensburg, KS 67054-2708 | 2006-09-01 |
| 1033122700 | Charles T Carpenter | Nurse Anesthetist, Certified Registered | 2333 Biddle St, Wyandotte, MI 48192-4668 | 2006-08-14 |
| 1477598431 | Charles M. Carpenter | Internal Medicine | 96 Campus Drive, Suite 1, Scarborough, ME 04074 | 2006-06-16 |
| 1063459774 | Charles C.j. Carpenter | Internal Medicine | 164 Summit Ave, Fain Bldg, Suite E, Providence, RI 02906-2853 | 2006-06-01 |
| 1194700112 | Charles Ernie Carpenter | Emergency Medicine | 4500 Medical Center Dr, Mckinney, TX 75069-1650 | 2005-12-13 |
| Street Address |
4300 W MAIN ST STE 21 |
| City | DOTHAN |
| State | AL |
| Zip Code | 36305-1058 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740285931 | Jason D. Beaver | Surgery | 4300 W Main St Ste 21, Dothan, AL 36305-1058 | 2005-06-15 |
| 1982025003 | Wendi Tice | Registered Nurse | 4300 W Main St Ste 21, Dothan, AL 36305-1058 | 2013-12-16 |
| 1184995292 | Jason Lee Cox | Nurse Practitioner | 4300 W Main St Ste 21, Dothan, AL 36305-1058 | 2012-01-20 |
| 1922072834 | Victor S Dreicer | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4300 W Main St Ste 21, Dothan, AL 36305-1058 | 2006-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962059998 | Samantha Nicole Bolden | Counselor | 1001 John D. Odom Road, Dothan, AL 36305 | 2019-08-23 |
| 1578968780 | Aba Therapy & Consulting Services | Behavioral Analyst | 3124 West Main Street, Suite 9, Dothan, AL 36305 | 2014-10-30 |
| 1306247796 | Tracey Lynn Carter | Registered Nurse | 4300 W Main St Ste 102, Dothan, AL 36305 | 2014-09-04 |
| 1760829881 | Michael Brent Nance | Nurse Practitioner | 4370 West Main Street, Dothan, AL 36305 | 2013-05-30 |
| 1033495221 | Professional Resource Management of Wiregrass, LLC | Psychiatry & Neurology | 2812 Hartford Hwy Ste 1, Dothan, AL 36305 | 2011-11-01 |
| 1649555483 | Ashley Dawn Morrow | Pharmacist | 2940 West Main Street, Dothan, AL 36305 | 2011-10-12 |
| 1740599273 | Aline M Mays-easley | Counselor | 309 Ameris Ave, Dothan, AL 36305 | 2010-10-01 |
| 1356671408 | Kimberly Jones Rogers | Clinical Neuropsychologist | 200 Grove Park Ln Ste 212, Dothan, AL 36305 | 2010-01-12 |
| 1639347818 | Southeast Alabama Counseling & Behavioral Specialist | Residential Treatment Facility, Emotionally Disturbed Children | 407 Honeysuckle Rd Ste 207, Dothan, AL 36305 | 2008-02-11 |
| 1770705667 | Michala Long | Pharmacist | 3850 West Main St, Dothan, AL 36305 | 2007-05-02 |
| Find all providers in zip 36305 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700190204 | Charles Fred Conner | Surgery | 47 Foxchase Dr, Dothan, AL 36305-1145 | 2010-07-27 |
| 1053396606 | Bryant Fleming Williams | Surgery | 1118 Ross Clark Cr, Suite 500, Dothan, AL 36301-3030 | 2005-12-07 |
| 1154316586 | Jeffrey Bray Whitehurst | Surgery | 112 Haven Drive, Suite 1, Dothan, AL 36301 | 2005-09-12 |
| 1396740577 | Steven M. Fendley | Surgery | 4300 W Main St, Ste 24, Dothan, AL 36305-1054 | 2005-06-15 |
| 1730184912 | Jonathan L. Skinner | Surgery | 1118 Ross Clark Cir, Ste 302, Dothan, AL 36301-3002 | 2005-06-15 |
| 1740285931 | Jason D. Beaver | Surgery | 4300 W Main St Ste 21, Dothan, AL 36305-1058 | 2005-06-15 |
| 1881057974 | Houston County Healthcare Authority | Surgery | 1812 E Main St, Dothan, AL 36301-3000 | 2016-04-05 |
| 1528340536 | Jonathan L Skinner LLC | Surgery | 1118 Ross Clark Cir, Ste 302, Dothan, AL 36301-3001 | 2011-09-15 |
| 1932497393 | Dothan Surgical Services, LLC | Surgery | 4300 W Main St, Dothan, AL 36305-1054 | 2011-07-19 |
| 1235443417 | Wiregrass Vascular, P.C. | Surgery | 112 Haven Dr, Suite 1, Dothan, AL 36301-2907 | 2010-07-30 |
| Find all providers in DOTHAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.