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General NPI Number Information
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NPI Number | 1437000627
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Entity Type | Individual
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Provider Name | DEDRIC CARROLL
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Gender | Male
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 659 AUBURN AVE NE STE G22
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City | ATLANTA
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State | GA
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Zip | 30312-1978
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Country | US
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Telephone | 404-980-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 659 AUBURN AVE NE STE G22
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City | ATLANTA
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State | GA
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Zip | 30312-1978
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Country | US
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Telephone | 404-980-0050
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Fax |
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | MT005549
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License Number State | GA
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