Provider Demographics
NPI:1679575484
Name:CARSON, DAVID STEPHEN SR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEPHEN
Last Name:CARSON
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1209 W WALNUT AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3961
Mailing Address - Country:US
Mailing Address - Phone:706-226-5300
Mailing Address - Fax:706-226-6277
Practice Address - Street 1:1209 W WALNUT AVE
Practice Address - Street 2:STE 6
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3961
Practice Address - Country:US
Practice Address - Phone:706-226-5300
Practice Address - Fax:706-226-6277
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA48336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00860098BMedicaid
GA110213705OtherMEDICARE RAILROAD PALMETT
GA52702469002OtherBCBS
H11477Medicare UPIN
GA11BDSJVMedicare ID - Type Unspecified