Healthcare Provider Details

I. General information

NPI: 1407176357
Provider Name (Legal Business Name): EDWARD CURTIS GARRETT III CONTRACTOR - CLASS C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 VOLENS ROAD
NATHALIE VA
24577
US

IV. Provider business mailing address

2175 VOLENS ROAD
NATHALIE VA
24577
US

V. Phone/Fax

Practice location:
  • Phone: 434-941-1158
  • Fax: 434-349-6514
Mailing address:
  • Phone: 434-941-1158
  • Fax: 434-349-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: