Provider Demographics
NPI:1528248002
Name:STACEY B. CARLTON, MD, PC
Entity type:Organization
Organization Name:STACEY B. CARLTON, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, EMT-P
Authorized Official - Phone:931-981-9809
Mailing Address - Street 1:229 INTERSTATE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2704
Mailing Address - Country:US
Mailing Address - Phone:931-981-9809
Mailing Address - Fax:931-456-2844
Practice Address - Street 1:229 INTERSTATE DR STE 105
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2704
Practice Address - Country:US
Practice Address - Phone:931-981-9809
Practice Address - Fax:931-456-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3849058Medicaid
TNF98622Medicare UPIN
TN3849058Medicaid