Provider Demographics
NPI:1457308470
Name:JAMES R CARROLL MD PA
Entity Type:Organization
Organization Name:JAMES R CARROLL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-431-2730
Mailing Address - Street 1:2845 E HIGHWAY 76
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-6037
Mailing Address - Country:US
Mailing Address - Phone:843-431-2730
Mailing Address - Fax:843-431-2735
Practice Address - Street 1:2845 E HIGHWAY 76
Practice Address - Street 2:SUITE 2
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6037
Practice Address - Country:US
Practice Address - Phone:843-431-2730
Practice Address - Fax:843-431-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4250Medicaid
SCD05777Medicare UPIN
SCGP4250Medicaid