Healthcare Provider Details

I. General information

NPI: 1962445650
Provider Name (Legal Business Name): MRS. BEVERLY ANITA GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 EAST SOUTH BLVD
MONTGOMERY AL
36116
US

IV. Provider business mailing address

PO BOX 235022
MONTGOMERY AL
36123-5022
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-2100
  • Fax:
Mailing address:
  • Phone: 334-386-2051
  • Fax: 334-396-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1102978
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: