Provider Demographics
NPI:1740305663
Name:PALMER, CARLETON A (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLETON
Middle Name:A
Last Name:PALMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5490 MCGINNIS VILLAGE PL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1733
Mailing Address - Country:US
Mailing Address - Phone:770-752-4224
Mailing Address - Fax:
Practice Address - Street 1:5490 MCGINNIS VILLAGE PL
Practice Address - Street 2:SUITE 112
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1733
Practice Address - Country:US
Practice Address - Phone:770-752-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical