Healthcare Provider Details

I. General information

NPI: 1366534745
Provider Name (Legal Business Name): MARK R CARROLL M.S., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 FRANKLIN ST SE SUITE 100
HUNTSVILLE AL
35801-4306
US

IV. Provider business mailing address

PO BOX 18066
HUNTSVILLE AL
35804-8066
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-9300
  • Fax: 256-535-9032
Mailing address:
  • Phone: 256-536-9300
  • Fax: 256-535-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5798
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: