Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 23733 | MS |
NPI | 1215100011 |
---|---|
Provider Name | Dr. Clinton Michael Carroll |
First Address | Nashville, TN 37203-1661 |
Second Address | Nashville, TN 37203-1661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2008 |
Last Update Date | 03/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q051112 | (05) | TN |