Healthcare Provider Details

I. General information

NPI: 1982522561
Provider Name (Legal Business Name): MR. JERRY GARNER SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W HARDEN ST
GRAHAM NC
27253-2105
US

IV. Provider business mailing address

2116 WHITSETT ST
BURLINGTON NC
27215-7220
US

V. Phone/Fax

Practice location:
  • Phone: 336-213-5819
  • Fax:
Mailing address:
  • Phone: 336-213-5819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: