Provider Demographics
NPI:1619517968
Name:CARROLL TOTAL HEALTHCARE,PC
Entity Type:Organization
Organization Name:CARROLL TOTAL HEALTHCARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-897-9867
Mailing Address - Street 1:2140 VICKI LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6556
Mailing Address - Country:US
Mailing Address - Phone:678-897-9867
Mailing Address - Fax:867-992-1277
Practice Address - Street 1:410 PEACHTREE PKWY STE 4226
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7439
Practice Address - Country:US
Practice Address - Phone:678-897-9867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty