Individual
DR. CLARK M CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD,PC
Contact information
Practice address
750 MEDICAL CENTER DR, EASTMAN, GA 31023-6736
(478) 374-7184
(478) 374-4238
Mailing address
PO BOX 4007, EASTMAN, GA 31023-4007
(478) 374-7184
(478) 374-4238
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8260
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00044976A
—
GA
05
—
100952
—
GA
05
—
9180290
—
GA
Enumeration date
04/10/2007
Last updated
07/09/2007
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