Healthcare Provider Details

I. General information

NPI: 1003757907
Provider Name (Legal Business Name): GARRETT K PICKETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GARY K PICKETT

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 LOTTSFORD VISTA RD
LANHAM MD
20706-4818
US

IV. Provider business mailing address

640 FREEDOM BUSINESS CTR DR STE 220
KING OF PRUSSIA PA
19406-1376
US

V. Phone/Fax

Practice location:
  • Phone: 484-965-9966
  • Fax: 484-231-8631
Mailing address:
  • Phone: 484-965-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: