Provider Demographics
NPI:1366545642
Name:CARLSON, JAMES LENNART (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LENNART
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:510 KINGSWORTH LN SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-8582
Mailing Address - Country:US
Mailing Address - Phone:910-383-2226
Mailing Address - Fax:910-654-1258
Practice Address - Street 1:7490 ANDREW JACKSON HWY.SW
Practice Address - Street 2:
Practice Address - City:CERRO GORDO
Practice Address - State:NC
Practice Address - Zip Code:28430
Practice Address - Country:US
Practice Address - Phone:910-654-2050
Practice Address - Fax:910-654-1258
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200200010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF70725Medicaid