Provider Demographics
NPI:1598779621
Name:GARRETT, JENNIFER H (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
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 1:1804 E SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-3637
Mailing Address - Country:US
Mailing Address - Phone:662-212-9001
Mailing Address - Fax:662-212-9004
Practice Address - Street 1:1804 E SHILOH RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-3637
Practice Address - Country:US
Practice Address - Phone:662-212-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17926207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09322378Medicaid
MS09322378Medicaid