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General NPI Number Information
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NPI Number | 1255321048
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Entity Type | Individual
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Provider Name | CLAYTON DANIEL CARROLL PAC
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 1800 MEDICAL CENTER PKWY SUITE 200
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City | MURFREESBORO
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State | TN
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Zip | 37129-2567
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Country | US
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Telephone | 615-896-6800
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Fax | 615-895-8890
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Provider Business Mailing Address
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Address Line | 608 NORRIS AVE
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City | NASHVILLE
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State | TN
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Zip | 37204-3708
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Country | US
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Telephone | 615-695-1432
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Fax | 615-695-1483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1037
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA1037
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1037
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License Number State | TN
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