Provider Demographics
NPI:1194013656
Name:MCCARROLL, RICHARD HISHAM (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HISHAM
Last Name:MCCARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-256-2657
Mailing Address - Fax:803-933-9545
Practice Address - Street 1:2 MEDICAL PARK
Practice Address - Street 2:STE. 306 SURGERY -
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-256-2657
Practice Address - Fax:803-933-9545
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33875208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery