Provider Demographics
NPI:1417847682
Name:CARPENTER, TATUM L
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GILLSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30543-2731
Mailing Address - Country:US
Mailing Address - Phone:770-561-6278
Mailing Address - Fax:
Practice Address - Street 1:1967 JESSE JEWELL PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:678-347-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty