Individual
DR. TRAVIS ROD CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(706) 264-1897
Mailing address
PO BOX 2645, DALTON, GA 30722-2645
(706) 264-1897
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
074111
GA
2080N0001X
Neonatal-Perinatal Medicine Physician
N5608
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003161386A
—
GA
05
—
213538601
—
TX
Enumeration date
05/23/2007
Last updated
01/12/2016
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