Provider Demographics
NPI:1417380908
Name:CARLTON, THOMAS JAMES (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:CARLTON
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5906
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31758-5906
Mailing Address - Country:US
Mailing Address - Phone:229-236-8989
Mailing Address - Fax:229-236-8990
Practice Address - Street 1:223 S CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5504
Practice Address - Country:US
Practice Address - Phone:229-236-8989
Practice Address - Fax:229-236-8990
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0117512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162470AMedicaid
LA1174173Medicaid
GA003162470AMedicaid