Provider Demographics
NPI:1407176357
Name:GARRETT, EDWARD CURTIS III (CONTRACTOR - CLASS C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CURTIS
Last Name:GARRETT
Suffix:III
Gender:M
Credentials:CONTRACTOR - CLASS C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 VOLENS ROAD
Mailing Address - Street 2:
Mailing Address - City:NATHALIE
Mailing Address - State:VA
Mailing Address - Zip Code:24577
Mailing Address - Country:US
Mailing Address - Phone:434-941-1158
Mailing Address - Fax:434-349-6514
Practice Address - Street 1:2175 VOLENS ROAD
Practice Address - Street 2:
Practice Address - City:NATHALIE
Practice Address - State:VA
Practice Address - Zip Code:24577
Practice Address - Country:US
Practice Address - Phone:434-941-1158
Practice Address - Fax:434-349-6514
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171WV0202XOther Service ProvidersContractorVehicle Modifications