MEDICARE: MR. FIELDING GARRETT CARROLL L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	TAC145	KY

General Provider Information

NPI Number	:	1770358038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FIELDING GARRETT CARROLL L.AC

Provider Business Mailing Address
First Line	:	3044 RING RD
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-7932
Country	:	US
Telephone Number	:	270-506-3853
Fax Number	:

Provider Business Practice Location Address
First Line	:	3044 RING RD
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-7932
Country	:	US
Telephone Number	:	270-506-3853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2023
Last Update Date	:	11/16/2023

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