Provider Demographics
NPI:1154593317
Name:ALLEN C. CARTER, PH.D, P.C.
Entity type:Organization
Organization Name:ALLEN C. CARTER, PH.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:CONNARD
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-874-9207
Mailing Address - Street 1:600 WEST PEACHTREE ST NW
Mailing Address - Street 2:SUITE 1570
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3607
Mailing Address - Country:US
Mailing Address - Phone:404-874-9207
Mailing Address - Fax:404-876-4262
Practice Address - Street 1:600 W PEACHTREE ST NW
Practice Address - Street 2:SUITE 1570
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3607
Practice Address - Country:US
Practice Address - Phone:404-874-9207
Practice Address - Fax:404-876-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00671101YM0800X, 302F00000X
302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00209426AMedicaid