Individual
DR. BRENDA ANN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
643 HIGHWAY 1 S, LUGOFF, SC 29078-9174
(928) 750-2891
Mailing address
1723 LAKEVIEW AVE, CAMDEN, SC 29020-2728
(928) 750-2891
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
053433
GA
207RH0003X
Hematology & Oncology Physician
41749
AZ
2083X0100X
Occupational Medicine Physician
Primary
15060
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52053633
BCBS
GA
05
—
893096988A
—
GA
Enumeration date
09/02/2005
Last updated
07/12/2024
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