Provider Demographics
NPI:1346832532
Name:CARVER, GARRETT BLAKE (DPH)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:BLAKE
Last Name:CARVER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 SPRING PLACE RD SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-8311
Mailing Address - Country:US
Mailing Address - Phone:423-447-2434
Mailing Address - Fax:
Practice Address - Street 1:3135 MAIN ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367-5752
Practice Address - Country:US
Practice Address - Phone:423-447-2434
Practice Address - Fax:423-447-6151
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
615407OtherNABP