Individual
JELISA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2916 GLYNN AVE, BRUNSWICK, GA 31520-4844
(912) 466-5850
(912) 267-7139
Mailing address
2916 GLYNN AVE, BRUNSWICK, GA 31520-4844
(921) 466-5850
(912) 267-7139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
86289
GA
Other
Enumeration date
05/11/2017
Last updated
07/12/2024
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