Provider Demographics
NPI:1255321048
Name:CARROLL, CLAYTON DANIEL (PAC)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:DANIEL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3708
Mailing Address - Country:US
Mailing Address - Phone:615-695-1432
Mailing Address - Fax:615-695-1483
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-896-6800
Practice Address - Fax:615-895-8890
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1037363AM0700X, 363AS0400X
TN1037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508210Medicaid
TNP76374Medicare UPIN
TN3661048Medicare ID - Type Unspecified