MEDICARE: SCOTT WHALEN CARROLL

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	103K00000X	Behavior Analyst	003193412	GA

General Provider Information

NPI Number	:	1760267454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT WHALEN CARROLL

Provider Business Mailing Address
First Line	:	6080 HEARDS CREEK DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3633
Country	:	US
Telephone Number	:	404-317-8888
Fax Number	:	404-943-9939

Provider Business Practice Location Address
First Line	:	6080 HEARDS CREEK DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3633
Country	:	US
Telephone Number	:	404-317-8888
Fax Number	:	404-943-9939

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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Directions to “ SCOTT WHALEN CARROLL ” Practice Location

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