Provider Demographics
NPI:1790447647
Name:CARTER, GABRIEL SHANNON
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:SHANNON
Last Name:CARTER
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 1:13 HUNTERS VW
Mailing Address - Street 2:
Mailing Address - City:EUHARLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30145-2834
Mailing Address - Country:US
Mailing Address - Phone:706-728-5394
Mailing Address - Fax:
Practice Address - Street 1:13 HUNTERS VW
Practice Address - Street 2:
Practice Address - City:EUHARLEE
Practice Address - State:GA
Practice Address - Zip Code:30145-2834
Practice Address - Country:US
Practice Address - Phone:706-728-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician