Provider Demographics
NPI:1578665246
Name:CARROLL, JAMES MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2021 N SLAPPEY BLVD
Mailing Address - Street 2:PMB 143
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1001
Mailing Address - Country:US
Mailing Address - Phone:229-432-5617
Mailing Address - Fax:229-432-5617
Practice Address - Street 1:1108 WHISPERING PINES RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3542
Practice Address - Country:US
Practice Address - Phone:229-432-5617
Practice Address - Fax:229-432-5617
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAGA1099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA1099OtherSTATE LICENSE NUMBER
GAU25555Medicare UPIN