Provider Demographics
NPI:1972510287
Name:CARLTON, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:CARLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8803
Mailing Address - Country:US
Mailing Address - Phone:601-898-7500
Mailing Address - Fax:601-898-7577
Practice Address - Street 1:5606 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-4217
Practice Address - Country:US
Practice Address - Phone:601-957-3333
Practice Address - Fax:601-957-3335
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120404Medicaid
LA1756911Medicaid
MS1559113OtherAMERICAN ADMIN GROUP
080134356OtherRAILROAD MEDICARE
MS1559113OtherAMERICAN ADMIN GROUP
LA1756911Medicaid