Provider Demographics
NPI:1457814618
Name:CARROLL, DYLAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:A
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1260 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5540
Mailing Address - Country:US
Mailing Address - Phone:478-352-8880
Mailing Address - Fax:478-352-8881
Practice Address - Street 1:1260 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5540
Practice Address - Country:US
Practice Address - Phone:478-352-8880
Practice Address - Fax:478-352-8881
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0007861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine