Healthcare Provider Details

I. General information

NPI: 1558944603
Provider Name (Legal Business Name): ZACK GARNER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 PIEDMONT RD NE STE 350
ATLANTA GA
30305-1582
US

IV. Provider business mailing address

4450 HUBERT MARTIN RD
CUMMING GA
30028-3268
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-2008
  • Fax:
Mailing address:
  • Phone: 678-936-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC010316
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: