Healthcare Provider Details

I. General information

NPI: 1154593317
Provider Name (Legal Business Name): ALLEN C. CARTER, PH.D, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W PEACHTREE ST NW SUITE 1570
ATLANTA GA
30308-3607
US

IV. Provider business mailing address

600 WEST PEACHTREE ST NW SUITE 1570
ATLANTA GA
30308-3607
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-9207
  • Fax: 404-876-4262
Mailing address:
  • Phone: 404-874-9207
  • Fax: 404-876-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number00671
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00671
License Number StateGA

VIII. Authorized Official

Name: DR. ALLEN CONNARD CARTER
Title or Position: PRESIDENT
Credential: PH.D
Phone: 404-874-9207