Provider Demographics
NPI:1750493185
Name:GARNER, CAROLYN N (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:N
Last Name:GARNER
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 1:3502 CORINTH PKWY UNIT 100
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5482
Mailing Address - Country:US
Mailing Address - Phone:940-380-8040
Mailing Address - Fax:940-380-8041
Practice Address - Street 1:3502 CORINTH PKWY UNIT 100
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5482
Practice Address - Country:US
Practice Address - Phone:940-380-8040
Practice Address - Fax:940-380-8041
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6627208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM6627OtherMEDICAL LICENSE
TX188352201Medicaid
TX8AH450OtherBC & BS
TX8F5933Medicare PIN