Healthcare Provider Details

I. General information

NPI: 1942382429
Provider Name (Legal Business Name): RICKY STEVEN GARLAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HIDDEN CREEK DR
GUYTON GA
31312-4590
US

IV. Provider business mailing address

PO BOX 386
SPRINGFIELD GA
31329-0386
US

V. Phone/Fax

Practice location:
  • Phone: 912-772-8620
  • Fax:
Mailing address:
  • Phone: 912-754-0380
  • Fax: 912-754-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004080
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004080
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: