Provider Demographics
NPI:1316230295
Name:GARNER, PETER BRIAN JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:BRIAN
Last Name:GARNER
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2299
Mailing Address - Country:US
Mailing Address - Phone:770-868-8222
Mailing Address - Fax:
Practice Address - Street 1:181 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2299
Practice Address - Country:US
Practice Address - Phone:770-868-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT006318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist