Provider Demographics
NPI:1316014533
Name:GARRETT, NEWTON B (OD)
Entity Type:Individual
Prefix:DR
First Name:NEWTON
Middle Name:B
Last Name:GARRETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2807
Mailing Address - Country:US
Mailing Address - Phone:770-534-5305
Mailing Address - Fax:770-536-5141
Practice Address - Street 1:4008 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2807
Practice Address - Country:US
Practice Address - Phone:770-534-5305
Practice Address - Fax:770-536-5141
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000005255AMedicaid
GA000005255AMedicaid
GAU22289Medicare UPIN