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General NPI Number Information
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NPI Number | 1093091209
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Entity Type | Organization
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Legal Business Name | CARROLL FAMILY PRACTICE
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 244 HIGHWAY 65 N SUITE 1
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City | CLINTON
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State | AR
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Zip | 72031-6390
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Country | US
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Telephone | 501-745-6100
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Fax | 501-745-6128
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Provider Business Mailing Address
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Address Line | PO BOX 808
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City | CLINTON
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State | AR
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Zip | 72031-0808
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Country | US
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Telephone | 501-745-6100
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Fax | 501-745-6128
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BARRY SCOTT CARROLL
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Credential | M.D.
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Telephone | 501-745-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C8231
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License Number State | AR
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