Healthcare Provider Details

I. General information

NPI: 1235049412
Provider Name (Legal Business Name): TERRENCE GARNER MSBMT LMT#4208
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 KAITLYN DR W
WALLS MS
38680-8527
US

IV. Provider business mailing address

5708 KAITLYN DR W
WALLS MS
38680-8527
US

V. Phone/Fax

Practice location:
  • Phone: 404-603-6072
  • Fax:
Mailing address:
  • Phone: 404-603-6072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4208
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: