Provider Demographics
NPI:1700838125
Name:GARRETT, JOHN BOSTIAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BOSTIAN
Last Name:GARRETT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9735 KINCEY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9120
Mailing Address - Country:US
Mailing Address - Phone:704-414-2840
Mailing Address - Fax:704-414-2860
Practice Address - Street 1:631 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3438
Practice Address - Country:US
Practice Address - Phone:704-864-7764
Practice Address - Fax:704-867-7894
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-03-31
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Provider Licenses
StateLicense IDTaxonomies
NC25022208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC206537CMedicare PIN
C83985Medicare UPIN
206537Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE#