Provider Demographics
NPI:1396704516
Name:CARROLL, JEFFREY W (PA C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-539-2728
Mailing Address - Fax:256-428-3423
Practice Address - Street 1:927 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-539-2728
Practice Address - Fax:256-428-3423
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1217363AS0400X
ALPA398363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009978285Medicaid
AL090219OtherUNITED HEALTHCARE
AL51000081OtherBCBS
AL7190662OtherAETNA
AL090219OtherUNITED HEALTHCARE
AL7190662OtherAETNA