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General NPI Number Information
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NPI Number | 1982149621
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Entity Type | Individual
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Provider Name | JACOB C CARROLL CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 04/07/2019
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Provider Practice Location Address
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Address Line | 935 WAYNE RD
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City | SAVANNAH
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State | TN
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Zip | 38372
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Country | US
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Telephone | 731-926-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 183 UNION AVE
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City | JACKSON
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State | TN
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Zip | 38301-6036
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Country | US
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Telephone | 731-926-0431
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Fax | 731-541-7075
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 22130
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License Number State | TN
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