Provider Demographics
NPI:1285749655
Name:QUARELLS, CARLTON LEE (PSY D)
Entity type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:LEE
Last Name:QUARELLS
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:DR
Other - First Name:CARLTON
Other - Middle Name:LEE
Other - Last Name:QUARELLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1850 LAKE PARK DR SE STE 106
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7642
Mailing Address - Country:US
Mailing Address - Phone:770-403-3124
Mailing Address - Fax:770-739-7659
Practice Address - Street 1:1850 LAKE PARK DR SE STE 106
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7642
Practice Address - Country:US
Practice Address - Phone:770-403-3124
Practice Address - Fax:770-739-7659
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000935426HMedicaid