| Doctor Name: | DR. KENNETH BRADFORD CARPENTER |
| NPI Number: | 1912315987 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 6768366-2501 |
| Business Practice Address: | 34 E Oak St East Ellijay, GA - 305408151 |
| Business Phone Number: | 7065155181 |
| Business Fax Number: | |
| Mailing Address: | 34 E Oak St, EAST ELLIJAY |
| State: | GA |
| Postal Code: | 305408151 |
| Phone Number: | 7065155181 |
| Fax Number: | |
| NPI Enumeration Date: | 07/23/2014 |
| NPI Last Update Date: | 11/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6768366-2501 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |