MEDICARE: MR. DAVID LAWRENCE CARPENTER PA-C

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	363A00000X	Physician Assistant	005079	GA
2	363AM0700X	Medical Physician Assistant		CO

General Provider Information

NPI Number	:	1851467716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID LAWRENCE CARPENTER PA-C

Provider Business Mailing Address
First Line	:	1365 CLINTON RD NE
Second Line	:	MASON TRANSPLANT CLINIC SUITE 6400
City	:	ATLANTA
State	:	GA
Zip	:	30322-0001
Country	:	US
Telephone Number	:	404-727-3599
Fax Number	:	404-727-8410

Provider Business Practice Location Address
First Line	:	1395 CLIFTON RD NE
Second Line	:	SUITE 6400
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-727-3599
Fax Number	:	404-727-8410

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	09/14/2015

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