Provider Demographics
NPI:1326620220
Name:BOND, GARRETT COLE (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:COLE
Last Name:BOND
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 HARDY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1331
Mailing Address - Country:US
Mailing Address - Phone:601-261-5700
Mailing Address - Fax:601-261-5777
Practice Address - Street 1:5003 HARDY ST STE 200
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1331
Practice Address - Country:US
Practice Address - Phone:601-261-5700
Practice Address - Fax:601-261-5777
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904463363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care