Healthcare Provider Details

I. General information

NPI: 1649376765
Provider Name (Legal Business Name): WILLIAM ALLAN GARRETT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ELK AVE
ELIZABETHTON TN
37643
US

IV. Provider business mailing address

365 STOUT DRIVE BOX 70403
JOHNSON CITY TN
37614-1703
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-2584
  • Fax: 423-722-2060
Mailing address:
  • Phone: 423-439-4515
  • Fax: 423-439-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37657
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: