Provider Demographics
NPI:1932221827
Name:IDDINS, CAROL J (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:IDDINS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:MS 39 REACTS
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37831-0117
Mailing Address - Country:US
Mailing Address - Phone:865-576-3131
Mailing Address - Fax:865-576-9522
Practice Address - Street 1:1299 BETHEL VALLEY RD
Practice Address - Street 2:BOX 117 REACTS
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8007
Practice Address - Country:US
Practice Address - Phone:865-576-3131
Practice Address - Fax:865-576-9522
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2012-08-30
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Provider Licenses
StateLicense IDTaxonomies
TN262172083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine