Provider Demographics
NPI:1881058386
Name:CALHOUN, CARLTON
Entity type:Individual
Prefix:
First Name:CARLTON
Middle Name:
Last Name:CALHOUN
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 1:6191 CROOKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-5008
Mailing Address - Country:US
Mailing Address - Phone:404-629-7378
Mailing Address - Fax:
Practice Address - Street 1:6191 CROOKED CREEK DR
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-5008
Practice Address - Country:US
Practice Address - Phone:404-629-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037883982172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver