Healthcare Provider Details

I. General information

NPI: 1407597818
Provider Name (Legal Business Name): WHITNEY WARD GARRETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 GRIFFIN AVE
EASTMAN GA
31023-6718
US

IV. Provider business mailing address

1462 SAINT MARK RD
DUBLIN GA
31021-7310
US

V. Phone/Fax

Practice location:
  • Phone: 478-374-1801
  • Fax:
Mailing address:
  • Phone: 478-697-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241454
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: