MEDICARE: GENA GARRARD RN

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	163WC1500X	Community Health Registered Nurse	108611	TN

General Provider Information

NPI Number	:	1386995801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENA GARRARD RN

Provider Business Mailing Address
First Line	:	1918 ROSS CREEK RD
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-5503
Country	:	US
Telephone Number	:	931-676-6931
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 JV MANGUBAT DR
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-2439
Country	:	US
Telephone Number	:	931-722-3292
Fax Number	:

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

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	09/24/2012

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