Provider Demographics
NPI:1689897563
Name:GARRETT, KEVIN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
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 1:7695 POPLAR PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5947
Mailing Address - Country:US
Mailing Address - Phone:901-685-2696
Mailing Address - Fax:
Practice Address - Street 1:7695 POPLAR PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-5947
Practice Address - Country:US
Practice Address - Phone:901-685-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN425472085R0202X
MS198782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology