Individual
ELBRETTA RENISE CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3117 BENTLEY FARMS DR, LOGANVILLE, GA 30052-3175
(470) 475-6911
Mailing address
226 ALCOVY ST STE A4, MONROE, GA 30655-2184
(770) 241-6905
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
COO87445
GA
Other
Enumeration date
04/01/2024
Last updated
11/15/2024
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