Healthcare Provider Details

I. General information

NPI: 1740142686
Provider Name (Legal Business Name): MICHAEL GARRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 HAMLIN SQ SW
ATLANTA GA
30331-7960
US

IV. Provider business mailing address

3542 HAMLIN SQ SW
ATLANTA GA
30331-7960
US

V. Phone/Fax

Practice location:
  • Phone: 678-799-2070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: