Provider Demographics
NPI:1891130829
Name:CARROLL, WILLIAM JESSUP (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JESSUP
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4007
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-4007
Mailing Address - Country:US
Mailing Address - Phone:478-374-7184
Mailing Address - Fax:
Practice Address - Street 1:3535 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4336
Practice Address - Country:US
Practice Address - Phone:478-374-7184
Practice Address - Fax:478-374-4238
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91276207W00000X, 207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003265416AMedicaid
GA003265416BMedicaid
GA003265416CMedicaid
GA003265416CMedicaid