Healthcare Provider Details

I. General information

NPI: 1124959960
Provider Name (Legal Business Name): REBECCA ABIGAIL CARROLL DCLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SERENDIPITY WAY
DALLAS GA
30157-2806
US

IV. Provider business mailing address

215 SERENDIPITY WAY
DALLAS GA
30157-2806
US

V. Phone/Fax

Practice location:
  • Phone: 334-392-1502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: