Provider Demographics
NPI:1417993643
Name:HARMON, CARROLL M (MD)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:M
Last Name:HARMON
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23731208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL370018130OtherRAILROAD MEDICARE
AL051520485OtherBLUE CROSS
AL051060813OtherBLUE CROSS
AL009946865Medicaid
AL051500217Medicaid
MS00124774OtherMISSISSIPPI MEDICAID
AL051520308OtherBLUE CROSS
LA1425435OtherEMERGENCY LA MEDICAID
AL000060813OtherBLUE CROSS
AL009943085Medicaid
AL051500217OtherBLUE CROSS
AL370018130OtherRAILROAD MEDICARE
AL009943085Medicaid