Provider Demographics
NPI:1528262045
Name:CARROLL, BRENT TIMOTHY (DO)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:TIMOTHY
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:410 PEACHTREE PKWY STE 4226
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7439
Mailing Address - Country:US
Mailing Address - Phone:678-341-9881
Mailing Address - Fax:678-341-9883
Practice Address - Street 1:410 PEACHTREE PKWY STE 4226
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7439
Practice Address - Country:US
Practice Address - Phone:678-341-9881
Practice Address - Fax:678-341-9883
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT308585-1204207Q00000X
GA060246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine