DR. KENNETH BRADFORD CARPENTER (PSYD) – Clinical Psychologist, NPI 1912315987
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
482 CLINICAL PSYCHOLOGIST in GA
Provider Addresses for DR. KENNETH BRADFORD CARPENTER (PSYD)
80 Cinema Drive
Ellijay, GA 305402592
Phone: (706) 635-6898
Fax: (706) 635-6885
Type: Location
79 Blue Ridge Overlook
Blue Ridge, GA 305134478
Phone: (706) 374-3100
Fax: (706) 374-7628
Type: Location
34 E OAK ST
EAST ELLIJAY, GA 305408151
Phone: (706) 515-5181
Type: Mailing
165 BLUE RIDGE OVERLOOK
BLUE RIDGE, GA 305134431
Phone: (706) 946-4647
Fax: (706) 374-5006
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-10-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20141013000746 | I | Clinical Psychologist | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30540)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | GA | |
| Family Practice | GA | |
| Nurse Practitioner | GA | |
| Nurse Practitioner | GA | |
| P O D I A T R Y | GA | |
| Internal Medicine | GA | |
| - | GA | |
| Nurse Practitioner | GA | |
| - | GA | |
| Nurse Practitioner | GA |
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