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General NPI Number Information
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NPI Number | 1891130829
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Entity Type | Individual
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Provider Name | WILLIAM JESSUP CARROLL MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 3535 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 770-520-8303
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Fax | 478-500-8205
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Provider Business Mailing Address
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Address Line | 3535 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 770-520-8303
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Fax | 478-500-8205
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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 | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 91276
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 91276
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License Number State | GA
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