MR. DOUGLAS JOHN CARROLL (NPI# 1649428277) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649428277 |
| Entity Type | Individual |
| Full Name | MR. DOUGLAS JOHN CARROLL |
| Credential | PA-C |
| Practice Address |
2410 Susannah St Johnson City TN 37601-1748 |
| Practice Telephone | 4232829011 |
| Mailing Telephone | 4232829011 |
| Mailing Fax Number | 7046390785 |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2020-06-30 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-01521 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 340 Steeles Rd, Bristol, TN 37620 | 4232829011 | 4232820035 |
| 875 Larry Neil Way, Kingsport, TN 376606368 | 4232829570 | 4232829572 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750622502 | Douglas Stephen Carroll | Physical Therapist | 21 W Golfview Rd, Havertown, PA 19083-1101 | 2013-03-04 |
| 1659619682 | Douglas Gordon Carroll IIi | Emergency Medicine | 1117 Greenspring Valley Rd, Lutherville, MD 21093-3611 | 2013-01-25 |
| Street Address |
2410 SUSANNAH ST |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37601-1748 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346223948 | Joseph R Hurst | Orthopaedic Surgery | 2410 Susannah St, Johnson City, TN 37601-1748 | 2005-11-28 |
| 1760098669 | Justin Alan Sylvester | Physical Therapy Assistant | 2410 Susannah St, Johnson City, TN 37601-1748 | 2020-09-17 |
| 1316562549 | Frankie Tidwell | Nurse Practitioner | 2410 Susannah St, Johnson City, TN 37601-1748 | 2020-06-12 |
| 1861025744 | Jalen Bridwell | Physical Therapist | 2410 Susannah St, Johnson City, TN 37601-1748 | 2020-02-19 |
| 1336786383 | Andrew Blythe | Physician Assistant | 2410 Susannah St, Johnson City, TN 37601-1748 | 2019-12-09 |
| 1659921294 | Emilee Grace Dishner | Physician Assistant | 2410 Susannah St, Johnson City, TN 37601-1748 | 2019-09-16 |
| 1154889285 | Taylor N Harmon | Physical Therapist | 2410 Susannah St, Johnson City, TN 37601-1748 | 2019-03-07 |
| 1407329246 | Mariah M Wagner | Physician Assistant | 2410 Susannah St, Johnson City, TN 37601-1748 | 2019-01-04 |
| 1497237416 | Micah A Mcfaddin | Physician Assistant | 2410 Susannah St, Johnson City, TN 37601-1748 | 2018-09-06 |
| 1245720382 | Stephanie Lynn Owen | Specialist/Technologist | 2410 Susannah St, Johnson City, TN 37601-1748 | 2018-05-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396381992 | Juan Carlos Simon Villegas Gomez | Specialist/Technologist | 1081 John Robert Bell Dr, Johnson City, TN 37601 | 2019-11-19 |
| 1629537279 | Jaima Suzanne Price | Hearing Instrument Specialist | 106 E Watauga Avenue, Johnson City, TN 37601 | 2019-03-13 |
| 1275004467 | Brittany Howell | Speech-Language Pathologist | 2114 E. Fairview Ave, Johnson City, TN 37601 | 2018-12-16 |
| 1194229948 | Heather Chantel Lester | Physical Therapist | 2114 E. Fairview Avenue, Johnson City, TN 37601 | 2018-03-19 |
| 1477061869 | Patrick Conway Reynolds | Specialist/Technologist | 1081 John Robert Bell Drive, Johnson City, TN 37601 | 2018-01-19 |
| 1790201135 | Surgical Services of East Tennessee PC | Surgery | 300 East Main St., Suite 301, Johnson City, TN 37601 | 2017-08-17 |
| 1073065694 | Davina Leah Reppond | Home Health | 1204 E Myrtle Ave, Johnsoncity, TN 37601 | 2016-10-31 |
| 1003365503 | Wendi Y Minutolo | Behavioral Analyst | 403 Princeton Rd Ste 3, Johnson City, TN 37601 | 2016-09-25 |
| 1306208798 | Rachel Anne Anderson | Nurse Practitioner | 1118 East Holston Avenue, Johnson City, TN 37601 | 2016-03-24 |
| 1932560976 | Kaydee Louise Davidson | Occupational Therapist | 3209 Bristol Highway, Johnson City, TN 37601 | 2016-03-18 |
| Find all providers in zip 37601 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821616590 | Brenda L Rankhorn | Physician Assistant | 402 Brookwood Dr, Johnson City, TN 37615-4924 | 2020-07-09 |
| 1336706183 | Andrew Thomas Rogers | Physician Assistant | 401 E Watauga Ave, Johnson City, TN 37601-4036 | 2019-05-28 |
| 1750859831 | Bethany Marie Zakrzewski | Physician Assistant | 410 N State of Franklin Rd Ste 120, Johnson City, TN 37604-6972 | 2018-11-07 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1417453440 | Blue Ridge Medical Management Corpoartion | Physician Assistant | 701 Med Tech Pkwy Ste 300, Johnson City, TN 37604-2365 | 2018-03-30 |
| 1083082838 | Amber Dykes | Physician Assistant | 119 Boone Ridge Dr Ste 201, Johnson City, TN 37615-8000 | 2015-09-10 |
| 1720336712 | Amy C Flint | Physician Assistant | 303 Med Tech Pkwy Ste 150, Johnson City, TN 37604-2394 | 2012-08-22 |
| 1568779155 | Tracy Mcwhorter Martino | Physician Assistant | 3 Professional Park Dr Ste 21, Johnson City, TN 37604-6529 | 2010-09-03 |
| 1932430741 | Lisa M Adams | Physician Assistant | 1301 Sunset Drive, Suite 3, Johnson City, TN 37604 | 2010-01-18 |
| 1265594618 | Whitney Diane Davis | Physician Assistant | 2514 Wesley St Ste 102, Johnson City, TN 37601-1764 | 2006-12-14 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37601 |
Please comment or provide details below to improve the information on MR. DOUGLAS JOHN CARROLL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.