Healthcare Provider Details

I. General information

NPI: 1265379259
Provider Name (Legal Business Name): CARLTON LEE CARPENTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-1000
  • Fax:
Mailing address:
  • Phone: 251-225-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: