Provider Demographics
NPI:1265643076
Name:GARNETT, WYVONIA SATINA (LPN)
Entity Type:Individual
Prefix:MS
First Name:WYVONIA
Middle Name:SATINA
Last Name:GARNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 MOUNT OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5611
Mailing Address - Country:US
Mailing Address - Phone:404-209-0534
Mailing Address - Fax:
Practice Address - Street 1:1701 HARDEE AVE SW
Practice Address - Street 2:
Practice Address - City:FT MCPHERSON
Practice Address - State:GA
Practice Address - Zip Code:30330
Practice Address - Country:US
Practice Address - Phone:404-464-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPN05727164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse