Individual
MR. DOUGLAS JOHN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Mailing address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
(704) 639-0785
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01521
NC
363A00000X
Physician Assistant
3434
TN
363AM0700X
Medical Physician Assistant
Primary
3434
TN
363AS0400X
Surgical Physician Assistant
3434
TN
Other
Enumeration date
09/08/2008
Last updated
09/30/2025
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