Healthcare Provider Details

I. General information

NPI: 1962368126
Provider Name (Legal Business Name): CHIKITA LAHESHIA GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HIGHWAY 80 W
CLINTON MS
39056-4108
US

IV. Provider business mailing address

604 HIGHWAY 80 W
CLINTON MS
39056-4108
US

V. Phone/Fax

Practice location:
  • Phone: 601-473-2106
  • Fax:
Mailing address:
  • Phone: 601-473-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: