Healthcare Provider Details

I. General information

NPI: 1508800905
Provider Name (Legal Business Name): HARVEY EDWARD GARRETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 WALNUT GROVE RD STE 301
MEMPHIS TN
38120-2123
US

IV. Provider business mailing address

PO BOX 638
MEMPHIS TN
38101-0638
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-0456
  • Fax: 901-226-0458
Mailing address:
  • Phone: 901-747-3066
  • Fax: 901-747-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number17068
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number17068
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: