Provider Demographics
NPI:1770929176
Name:CARROLL, ADAM BENJAMIN
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:BENJAMIN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 VILLAGE ST
Mailing Address - Street 2:STE 2
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6482
Mailing Address - Country:US
Mailing Address - Phone:256-551-4433
Mailing Address - Fax:256-551-4633
Practice Address - Street 1:201 DOUG BAKER BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2013
Practice Address - Country:US
Practice Address - Phone:256-551-4433
Practice Address - Fax:256-551-4633
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine