Provider Demographics
NPI:1821489782
Name:EMERSON, CARROLL (HIS)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:
Last Name:EMERSON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MALL BLVD # 104
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4862
Mailing Address - Country:US
Mailing Address - Phone:912-354-0029
Mailing Address - Fax:
Practice Address - Street 1:401 MALL BLVD # 104
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4862
Practice Address - Country:US
Practice Address - Phone:912-354-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000921237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist