Provider Demographics
NPI:1619976941
Name:CARLTON, STACEY B (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:B
Last Name:CARLTON
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 1:229 INTERSTATE DR
Mailing Address - Street 2:STE 105
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38490581Medicaid
TNF98622Medicare UPIN
TN38490581Medicare PIN