Healthcare Provider Details

I. General information

NPI: 1346832532
Provider Name (Legal Business Name): GARRETT BLAKE CARVER DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 MAIN ST
PIKEVILLE TN
37367-5752
US

IV. Provider business mailing address

3901 SPRING PLACE RD SE
CLEVELAND TN
37323-8311
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-2434
  • Fax: 423-447-6151
Mailing address:
  • Phone: 423-447-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37414
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: