# DR. MACON DEVAUGHN CARROLL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1083960504
- **Gender:** Man
- **Credential:** PHARM.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 0000036920 | TN | Yes |

## Other

- **Enumeration date:** 08/02/2012
- **Last updated:** 12/06/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 36920 | BOARD OF PHARMACY LICENSE | TN |