Clark M Carroll, DMD,PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8260 Issued in GA

Practice address

750 Medical Center Dr
Eastman, GA 31023-6736

Phone

(478) 374-7184

Fax

(478) 374-4238

NPI assigned

Apr 10, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peach State Retina, LLC

  • Retina Specialist (Ophthalmology) Physician
  • Loganville, GA
  • NPI 1568253110
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1669595880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4007",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310234007",
            "telephone_number": "478-374-7184",
            "fax_number": "478-374-4238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MEDICAL CENTER DR",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236736",
            "telephone_number": "478-374-7184",
            "fax_number": "478-374-4238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "CLARK",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DMD,PC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "8260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00044976A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100952",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9180290",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Nicole Bryant, NP-C
• Ashley Nichole Butler
• Randy James Cammack, LDO
• Careconnect Health, Inc. (CareConnect Convenient Care and Pediatrics)
• Robert Todd Carey, LP,CP
• Chandler Womens Health Center
• Zachary Bryan Chaney, MSN, APRN, FNP-C
• Joe Franklin Chapman
• Chattahoochee Family Orthodontics
• Children and Teen Dental Group (American Dental of Eastman)

• General Practice Dentistry in Eastman, GA
• Providers in Eastman, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.