Individual
CHRISTOPHER SHANE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
10706 MARLBORO AVE., BARNWELL, SC 29812-2516
(803) 259-7337
Mailing address
86 WREN ST, BARNWELL, SC 29812-1529
(803) 259-5762
(803) 259-3250
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20366
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20366
MEDICAL LICENSE
SC
05
—
NP4003
—
SC
Enumeration date
07/25/2016
Last updated
01/11/2024
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