Provider Demographics
NPI:1518722412
Name:SMALLS, GARREN DAYLE II
Entity Type:Individual
Prefix:
First Name:GARREN
Middle Name:DAYLE
Last Name:SMALLS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S ELLIOTT RD APT 541
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2636
Mailing Address - Country:US
Mailing Address - Phone:770-355-5016
Mailing Address - Fax:
Practice Address - Street 1:625 S ELLIOTT RD APT 541
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2636
Practice Address - Country:US
Practice Address - Phone:770-355-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health