Provider Demographics
NPI:1912458456
Name:CARPENTER, JOEL PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:PHILIP
Last Name:CARPENTER
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 1:1605 ROBERTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008
Mailing Address - Country:US
Mailing Address - Phone:770-419-3120
Mailing Address - Fax:770-419-3121
Practice Address - Street 1:1605 ROBERTA DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-3855
Practice Address - Country:US
Practice Address - Phone:770-419-3120
Practice Address - Fax:770-419-3121
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 59150207Q00000X
IL77437207Q00000X
TN26790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine