MEDICARE: BONNIE L CARLTON M.D.

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	207R00000X	Internal Medicine Physician	039748	GA

General Provider Information

NPI Number	:	1437275633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE L CARLTON M.D.

Provider Business Mailing Address
First Line	:	1165 SAINT CHARLES PL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4522
Country	:	US
Telephone Number	:	404-249-8065
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 SAINT CHARLES PL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4522
Country	:	US
Telephone Number	:	404-249-8065
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/16/2009

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