Provider Demographics
NPI:1013041904
Name:GARMON, JEFFERY SCOTT (CPED)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:SCOTT
Last Name:GARMON
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6105
Mailing Address - Country:US
Mailing Address - Phone:828-328-9844
Mailing Address - Fax:828-324-4059
Practice Address - Street 1:20 2ND ST NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6105
Practice Address - Country:US
Practice Address - Phone:828-328-9844
Practice Address - Fax:828-324-4059
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704439Medicaid
NC7795233Medicaid
NC046Y5OtherBCBS OF NC
NC046Y5OtherBCBS OF NC