Provider Demographics
NPI:1437174570
Name:GARRETT, JOSHUA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:L
Last Name:GARRETT
Suffix:
Gender:M
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:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-1808
Mailing Address - Country:US
Mailing Address - Phone:706-754-2155
Mailing Address - Fax:706-754-2166
Practice Address - Street 1:225 ADAMS DR STE A
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4578
Practice Address - Country:US
Practice Address - Phone:706-754-2155
Practice Address - Fax:706-754-2166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA206126OtherBCBS
GAHOSP60OtherMEDICARE GROUP
GA01056600OtherAMERIGROUP
GA247818875AMedicaid
GA403069OtherWELLCARE
GA01056600OtherAMERIGROUP
GA08CBCNQMedicare ID - Type Unspecified