Healthcare Provider Details

I. General information

NPI: 1194931345
Provider Name (Legal Business Name): VIRGINIA P CARROLL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N PATTERSON ST
VALDOSTA GA
31602-1720
US

IV. Provider business mailing address

2910 N PATTERSON ST
VALDOSTA GA
31602-1720
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-2562
  • Fax: 229-249-0000
Mailing address:
  • Phone: 229-244-2562
  • Fax: 229-249-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD003656
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: