Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 34941 | SC |
Y | 207YP0228X | Pediatric Otolaryngology | 34941 | SC |
N | 207YP0228X | Pediatric Otolaryngology | 61846 | MN |
N | 207YP0228X | Pediatric Otolaryngology | 79892 | GA |
NPI | 1124380084 |
---|---|
Provider Name | William Wise Crosby Carroll |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070892 | MEDICAL LICENSE (01) | GA |