Provider Demographics
NPI:1609816735
Name:CARROLL, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC10340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC103408Medicaid
SC103408Medicaid
SCD05777Medicare UPIN