MEDICARE: MR. CARLTON D HAGGARD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW001456	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	148495000	OTHER	GA	MAGELLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	087343	OTHER	GA	VALUE OPTIONS
5	PVPB63279	OTHER	GA	AMERICAN PSYCH SYSTEMS
6	298302	OTHER	GA	CCN
7	196693	OTHER	GA	COMPSYCH
8	087343	OTHER	GA	ONE HEALTH PLAN
9	1015098	OTHER	GA	CIGNA BEHAVIORAL HEALTH
10	52426630-003	OTHER	GA	BLUE CROSS BLUE SHIELD
11	178135	OTHER	GA	MENTAL HEALTH NETWORK
12	843297	OTHER	GA	FIRST HEALTH
13	087343	OTHER	GA	GREAT WEST
14	085079	OTHER	GA	MANAGED HEALTH NETWORK
15	388692	OTHER	GA	AMERIHEALTH ADMINISTRATOR
16	62-04486	OTHER	GA	UNITED BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1083617351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLTON D HAGGARD LCSW

Provider Business Mailing Address
First Line	:	4015 S COBB DR SE
Second Line	:	STE 4
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	770-435-2931
Fax Number	:	770-435-2942

Provider Business Practice Location Address
First Line	:	4015 S COBB DR SE
Second Line	:	STE 4
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	770-435-2931
Fax Number	:	770-435-2942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/09/2007

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