Individual
DR. MACON DEVAUGHN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
107 JV MANGUBAT DR, WAYNESBORO, TN 38485-2440
(931) 722-2296
(931) 722-3464
Mailing address
215 DEXTER L WOODS MEMORIAL BLVD, WAYNESBORO, TN 38485-2416
(931) 722-5466
(931) 722-9495
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0000036920
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36920
BOARD OF PHARMACY LICENSE
TN
Enumeration date
08/02/2012
Last updated
12/06/2022
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