Basic Information
| Provider Information | |||||||||
| NPI: | 1649279811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARVER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 535744 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303535510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442945114 | ||||||||
| FaxNumber: | 8656910843 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 W RAVINE RD | ||||||||
| Address2: | SUITE 5-B | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232243460 | ||||||||
| FaxNumber: | 4232243465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 21694 | TN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3042034 | 01 | BS OF TN | OTHER | 281112 | 01 | ANTHEM BCBS | OTHER | P050053051 | 01 | RAILROAD MEDICARE | OTHER | 100010714 | 05 | TN | MEDICAID | 3804029 | 05 | TN | MEDICAID | TN0100 | 01 | JOHN DEERE | OTHER | 00013859 | 01 | NHC CARE ADMIN. | OTHER | 005706271 | 05 | VA | MEDICAID |