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General NPI Number Information
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NPI Number | 1104251412
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Entity Type | Organization
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Legal Business Name | W. JACKSON GARNER D.M.D
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 2129 FORESTDALE BLVD
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City | FORESTDALE
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State | AL
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Zip | 35214-1523
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Country | US
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Telephone | 205-798-6561
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Fax | 205-285-9663
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Provider Business Mailing Address
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Address Line | 2129 FORESTDALE BLVD
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City | FORESTDALE
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State | AL
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Zip | 35214-1523
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Country | US
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Telephone | 205-798-6561
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Fax | 205-285-9663
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WALTER JACKSON GARNER
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Credential | D.M.D
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Telephone | 205-798-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 5113
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License Number State | AL
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