Healthcare Provider Details

I. General information

NPI: 1831413426
Provider Name (Legal Business Name): JOE GARMON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GORDON AVE
THOMASVILLE GA
31792-6640
US

IV. Provider business mailing address

200 GORDON AVE
THOMASVILLE GA
31792-6640
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-0741
  • Fax: 229-227-9360
Mailing address:
  • Phone: 229-226-0741
  • Fax: 229-227-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY002910
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002353
License Number StateGA

VIII. Authorized Official

Name: DR. JOSEPH M GARMON
Title or Position: OWNER
Credential: PH.D.
Phone: 229-226-0741