Healthcare Provider Details

I. General information

NPI: 1194601922
Provider Name (Legal Business Name): GEORGIA GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 E MONTAGUE AVE STE 101
NORTH CHARLESTON SC
29405-4974
US

IV. Provider business mailing address

1043 E MONTAGUE AVE STE 101
NORTH CHARLESTON SC
29405-4974
US

V. Phone/Fax

Practice location:
  • Phone: 843-273-6118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30813
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: