Individual
DR. CHARLES SHANNON CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
291 E LAYFAIR DR, FLOWOOD, MS 39232-9527
(601) 936-9190
(601) 932-6714
Mailing address
291 E LAYFAIR DR, FLOWOOD, MS 39232-9527
(601) 936-9190
(601) 932-6714
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
15901
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120136
—
MS
Enumeration date
07/03/2006
Last updated
04/20/2011
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