Individual
MR. MATTHEW L. CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
(901) 759-3196
Mailing address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
(901) 759-3196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
200682
LA
363A00000X
Physician Assistant
3336
TN
363A00000X
Physician Assistant
Primary
3366
TN
363A00000X
Physician Assistant
MPA.1778.TL
SC
363A00000X
Physician Assistant
PA00386
MS
363A00000X
Physician Assistant
PA180137
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07004261
—
MS
01
—
1102675
NCCPA
—
05
—
2351991
—
LA
01
—
MPA.1778.TL
SOUTH CAROLINA PA LICENSE
SC
05
—
Q031131
—
TN
Enumeration date
07/19/2012
Last updated
10/07/2022
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