Provider Demographics
NPI:1205830239
Name:GARRETT, DANA LEANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LEANN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4335
Mailing Address - Country:US
Mailing Address - Phone:919-775-1115
Mailing Address - Fax:919-775-1113
Practice Address - Street 1:125 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4335
Practice Address - Country:US
Practice Address - Phone:919-775-1115
Practice Address - Fax:919-775-1113
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0138705OtherUNITED HEALTHCARE
NC080124251OtherRR MEDICARE
NC11033OtherBLUE CROSS BLUE SHIELD
NC8911033Medicaid
NC270331OtherMAMSI
NC76192OtherMEDCOST
NC20898OtherPARTNERS
NC270331OtherMAMSI
NC8911033Medicaid