Provider Demographics
NPI:1689701781
Name:GARRETT, BETH AYN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:AYN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 CHESTNUT HILL CIR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4607
Mailing Address - Country:US
Mailing Address - Phone:770-425-8970
Mailing Address - Fax:
Practice Address - Street 1:4075 PACES FERRY RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3009
Practice Address - Country:US
Practice Address - Phone:404-262-3032
Practice Address - Fax:404-479-8451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0001532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer