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General NPI Number Information
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NPI Number | 1841002102
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Entity Type | Organization
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Legal Business Name | SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 32 CORPORATE DR
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City | GRANTSVILLE
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State | MD
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Zip | 21536-1259
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Country | US
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Telephone | 301-895-8750
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Fax | 301-895-8751
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Provider Business Mailing Address
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Address Line | PO BOX 1647
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City | MORGANTOWN
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State | WV
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Zip | 26507-1647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, FINANCE
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Name | LORI DIXON
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Credential |
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Telephone | 301-533-4251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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