Provider Demographics
NPI:1073644985
Name:CARROLL, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST SYBELIA AVENUE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4750
Mailing Address - Country:US
Mailing Address - Phone:407-894-9959
Mailing Address - Fax:
Practice Address - Street 1:100 EAST SYBELIA AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4750
Practice Address - Country:US
Practice Address - Phone:407-894-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14431AMedicare ID - Type Unspecified