Provider Demographics
NPI:1407814403
Name:GARRETT, TOLLY (MD)
Entity Type:Individual
Prefix:MRS
First Name:TOLLY
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 NORTH POINT PKWY, SUITE 410
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-664-0088
Mailing Address - Fax:770-664-8228
Practice Address - Street 1:3180 NORTH POINT PKWY, SUITE 410
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-664-0088
Practice Address - Fax:770-664-8228
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236384208000000X
NC9600311208000000X
GA72892208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10108454Medicaid
VA10234646Medicaid
VA10145783Medicaid
VA10145741Medicaid
VA10145783Medicaid