Healthcare Provider Details

I. General information

NPI: 1629090782
Provider Name (Legal Business Name): JAMES GARNETTIII MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
ST. PETE FL
33744
US

IV. Provider business mailing address

PO BOX 263444
TAMPA FL
33685-3444
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 727-398-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberISW 1897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: