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General NPI Number Information
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NPI Number | 1992632574
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Entity Type | Individual
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Provider Name | LANE LAWSON CARROLL
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Gender | Male
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 565 RADIO HILL RD
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City | MARION
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State | VA
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Zip | 24354-6587
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Country | US
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Telephone | 276-944-6342
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 MOORLAND AVE
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City | BRISTOL
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State | VA
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Zip | 24201-2775
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Country | US
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Telephone | 423-300-3175
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | VA
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