Provider Demographics
NPI:1851467716
Name:CARPENTER, DAVID LAWRENCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1365 CLINTON RD NE
Mailing Address - Street 2:MASON TRANSPLANT CLINIC SUITE 6400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-727-3599
Mailing Address - Fax:404-727-8410
Practice Address - Street 1:1395 CLIFTON RD NE
Practice Address - Street 2:SUITE 6400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-727-3599
Practice Address - Fax:404-727-8410
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005079363A00000X
CO363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC509968Medicare ID - Type Unspecified
COP97740Medicare UPIN