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General NPI Number Information
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NPI Number | 1386995439
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Entity Type | Organization
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Legal Business Name | PHYLLIS A GARRETT
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 386 MERRYDALE DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-3167
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Country | US
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Telephone | 678-354-6933
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Fax |
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Provider Business Mailing Address
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Address Line | 386 MERRYDALE DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-3167
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Country | US
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Telephone | 678-354-6933
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Fax |
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | MRS. PHYLLIS ANDREA GARRETT
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Credential | MEDICAL
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Telephone | 67835469336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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