Individual
MR. JONATHAN DAVID CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5452
(601) 815-3322
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5452
(601) 815-3322
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
24140
MS
208600000X
Surgery Physician
MD.203223
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06027230
—
MS
05
—
09978
—
LA
01
—
P01816798
RAILROAD MEDICARE
MS
Enumeration date
05/25/2007
Last updated
05/03/2017
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