Healthcare Provider Details

I. General information

NPI: 1205549763
Provider Name (Legal Business Name): MATLIE GARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 6TH AVE S RM M755B
BIRMINGHAM AL
35233-1920
US

IV. Provider business mailing address

1021 GREENDALE DR
HELENA AL
35022-7263
US

V. Phone/Fax

Practice location:
  • Phone: 205-887-3072
  • Fax:
Mailing address:
  • Phone: 205-394-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-148275
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-148275
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: