Provider Demographics
NPI:1427104660
Name:CARROLL, PAUL (EDS)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BUFORD HWY STE R6
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8777
Mailing Address - Country:US
Mailing Address - Phone:770-831-9874
Mailing Address - Fax:770-831-9874
Practice Address - Street 1:1400 BUFORD HWY STE R6
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-8777
Practice Address - Country:US
Practice Address - Phone:770-831-9874
Practice Address - Fax:770-831-9874
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional