Provider Demographics
NPI:1386684355
Name:GARLAND, PERITHA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:PERITHA
Middle Name:
Last Name:GARLAND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 WASHINGTON VILLAGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3994
Mailing Address - Country:US
Mailing Address - Phone:937-439-4145
Mailing Address - Fax:937-439-4371
Practice Address - Street 1:7740 WASHINGTON VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3994
Practice Address - Country:US
Practice Address - Phone:937-439-4145
Practice Address - Fax:937-439-4371
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000345039OtherANTHEM
OHP00216286OtherRAILROAD MEDICARE
OH0085227Medicaid
GAPA22512Medicare PIN