Provider Demographics
NPI:1760267454
Name:CARROLL, SCOTT WHALEN
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WHALEN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 HEARDS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3633
Mailing Address - Country:US
Mailing Address - Phone:404-317-8888
Mailing Address - Fax:404-943-9939
Practice Address - Street 1:6080 HEARDS CREEK DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3633
Practice Address - Country:US
Practice Address - Phone:404-317-8888
Practice Address - Fax:404-943-9939
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003193412103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst