Provider Demographics
NPI:1417373531
Name:GARNETT, DESHAWNDA (MSN)
Entity Type:Individual
Prefix:
First Name:DESHAWNDA
Middle Name:
Last Name:GARNETT
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 SIDELINE CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3552
Mailing Address - Country:US
Mailing Address - Phone:404-312-3984
Mailing Address - Fax:
Practice Address - Street 1:950 SIDELINE CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3552
Practice Address - Country:US
Practice Address - Phone:404-312-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF0913433OtherAMERCIAN ACADEMY OF NURSE PRACTITIONERS CETIFICATION PROGRAM