Provider Demographics
NPI:1184673774
Name:CARPENTER, GILLIAN A (MD)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 NEWBERRY POINT DR
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2754
Mailing Address - Country:US
Mailing Address - Phone:770-561-5131
Mailing Address - Fax:
Practice Address - Street 1:5732 NEWBERRY POINT DR
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-2754
Practice Address - Country:US
Practice Address - Phone:770-561-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0513012080P0202X
GA053101208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000973398BMedicaid
06BDHZLMedicare ID - Type Unspecified