Individual
KENNETH CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
461 COOK ST, SUITE B, ROYSTON, GA 30662-4003
(706) 245-1877
(706) 245-1433
Mailing address
461 COOK ST, SUITE B, ROYSTON, GA 30662-4003
(706) 245-1877
(706) 245-1433
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
018369
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4505967
AETNA PROV NUMBER
GA
01
—
975810
BCBS PIN NUMBER
GA
Enumeration date
12/21/2006
Last updated
07/08/2007
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