Provider Demographics
NPI:1609952589
Name:GARRETT, GEORGE ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALEXANDER
Last Name:GARRETT
Suffix:
Gender:M
Credentials:OD
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 589
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-0589
Mailing Address - Country:US
Mailing Address - Phone:706-628-5720
Mailing Address - Fax:706-884-2804
Practice Address - Street 1:121 DOGWOOD LANE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:GA
Practice Address - Zip Code:31811-0589
Practice Address - Country:US
Practice Address - Phone:706-628-5720
Practice Address - Fax:706-884-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA943-T152W00000X
ALS-466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51502048GAROtherBC/BS - ALABAMA
GA00301826BMedicaid
GA00301826BMedicaid
ALU78230Medicare UPIN
GAU78230Medicare UPIN