Provider Demographics
NPI:1417473422
Name:GARRETT, JUSTIN D (CAA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:GARRETT
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 UNIVERSITY BLVD # UH0481
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-274-0275
Mailing Address - Fax:317-274-0256
Practice Address - Street 1:550 UNIVERSITY BLVD # UH0481
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-0275
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN75000017A367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant