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1124092630

NPI Code Detail

MEDICARE: FRED T GARNER MD

MEDICARE: FRED T GARNER MD

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	207Y00000X	Otolaryngology Physician	16045	SC
2	207YP0228X	Pediatric Otolaryngology Physician	16045	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	570667594	OTHER	SC	TAX ID
2	204836403	OTHER	SC	TAX ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124092630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED T GARNER MD

Provider Business Mailing Address
First Line	:	2295 HENRY TECKLENBURG DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-7801
Country	:	US
Telephone Number	:	843-766-7103
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ARBOR LAKE DR STE 120
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4516
Country	:	US
Telephone Number	:	843-766-7103
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/18/2021

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Directions to “ FRED T GARNER MD” Practice Location

Language	Start Address	Practice Location

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