Healthcare Provider Details

I. General information

NPI: 1619902749
Provider Name (Legal Business Name): TINA S GARRETT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N ELAM AVE
GREENSBORO NC
27403-1127
US

IV. Provider business mailing address

300 E WENDOVER AVE
GREENSBORO NC
27401-1229
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-1745
  • Fax: 336-547-1824
Mailing address:
  • Phone: 336-663-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103372
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: