Provider Demographics
NPI:1114220753
Name:FLETCHER, GARLAN M
Entity Type:Individual
Prefix:
First Name:GARLAN
Middle Name:M
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:1065 SENATOR KEATING BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2600
Practice Address - Country:US
Practice Address - Phone:585-232-4205
Practice Address - Fax:585-262-3058
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000030416237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist