Provider Demographics
NPI:1174536387
Name:CARPENTER, WALTER A (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:A
Last Name:CARPENTER
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Gender:M
Credentials:PHD, MD
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Mailing Address - Street 1:59 EXECUTIVE PARK SOUTH
Mailing Address - Street 2:RADIOLOGY - 4TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-778-5834
Mailing Address - Fax:404-778-7015
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:RADIOLOGY - 4TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-5834
Practice Address - Fax:404-778-7015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GAE596702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology