Healthcare Provider Details

I. General information

NPI: 1912054222
Provider Name (Legal Business Name): LESLIE WAYNE GARRETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RIVERSIDE BLVD
EAST PALATKA FL
32131-4353
US

IV. Provider business mailing address

PO BOX 752
EAST PALATKA FL
32131-0752
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-3815
  • Fax:
Mailing address:
  • Phone: 386-325-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberME30625
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number9935
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD00042982
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME30625
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD00042982
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME30625
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number9935
License Number StateND
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00042982
License Number StateWA
# 9
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME30625
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9935
License Number StateND
# 11
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number9935
License Number StateND
# 12
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD00042982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: