Provider Demographics
NPI:1205850492
Name:CARLTON, ERNEST H (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:H
Last Name:CARLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 HEMLOCK ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8310
Mailing Address - Country:US
Mailing Address - Phone:478-744-9683
Mailing Address - Fax:478-744-9824
Practice Address - Street 1:682 HEMLOCK ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8310
Practice Address - Country:US
Practice Address - Phone:478-744-9683
Practice Address - Fax:478-744-9824
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046056207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000813788CMedicaid
GAG86818Medicare UPIN
GA16BDTXJMedicare ID - Type Unspecified