Basic Information
| Provider Information | |||||||||
| NPI: | 1992478739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLTON | ||||||||
| FirstName: | MEG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2295 HENRY CLOWER BLVD | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300785707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709959600 | ||||||||
| FaxNumber: | 6783834556 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 OGLETHORPE AVE STE A2 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709959600 | ||||||||
| FaxNumber: | 6783834556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2021 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT008107 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.