Healthcare Provider Details

I. General information

NPI: 1205194834
Provider Name (Legal Business Name): JESSICA J GARRETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

46844 WOODFIELD DR
MATTAWAN MI
49071-8636
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8282
  • Fax:
Mailing address:
  • Phone: 408-621-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57.021953
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35129076
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: