Healthcare Provider Details

I. General information

NPI: 1174701684
Provider Name (Legal Business Name): EMILY LUISA CARROLL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY LUISA LOPEZ

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

IV. Provider business mailing address

1323 ATLANTA AVE SW
CULLMAN AL
35055-4918
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-4000
  • Fax:
Mailing address:
  • Phone: 256-727-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.2320
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: