Healthcare Provider Details

I. General information

NPI: 1699705228
Provider Name (Legal Business Name): DAVID WILLIAM CARLTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RIVERBEND DR SW
ROME GA
30161-6066
US

IV. Provider business mailing address

8200 ROBERTS DR STE 450
SANDY SPRINGS GA
30350-4115
US

V. Phone/Fax

Practice location:
  • Phone: 706-234-0094
  • Fax: 877-761-3771
Mailing address:
  • Phone: 770-485-3723
  • Fax: 678-803-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number041749
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: