Healthcare Provider Details

I. General information

NPI: 1831182658
Provider Name (Legal Business Name): SUSAN ELLEN CARPENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CONCOURSE PKWY STE 250
ATLANTA GA
30328-6278
US

IV. Provider business mailing address

6 CONCOURSE PKWY STE 250
ATLANTA GA
30328-6278
US

V. Phone/Fax

Practice location:
  • Phone: 678-597-9933
  • Fax: 678-726-8183
Mailing address:
  • Phone: 678-597-9933
  • Fax: 678-726-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number037502
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: