Provider Demographics
NPI:1760424741
Name:GARNETT, LOCKETT WOOTTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LOCKETT
Middle Name:WOOTTON
Last Name:GARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:5899 BREMO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1935
Practice Address - Country:US
Practice Address - Phone:804-288-8512
Practice Address - Fax:804-288-4552
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA101032182207XS0114X
VA0101032182207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006400728Medicaid
VA2138275OtherUNITED HEALTHCARE MAMSI
VA46420OtherOPTIMA HEALTH
VA1760424741Medicaid
VA285573OtherSOUTHERN HEALTH
VA540885859OtherC&O EMPLOYEE'S HEALTHCARE
VA200015992OtherRAILROAD MEDICARE
VA30957OtherSH CARENETQ
VA386531OtherANTHEM WEST END OPERATORY
VA0536778OtherAETNA HMO
VA540885859OtherCIGNA
VA006400795Medicaid
VA0900340OtherUNITED HEALTHCARE
VA090514OtherANTHEM HEALTHKEEPERS
VA540885859OtherFIRST HEALTH/CCN
VA540885859OtherPRIVATE HEALTHCARE SYSTEM
VA540885859OtherFOCUS
VA200000632Medicare PIN
VA0900340OtherUNITED HEALTHCARE
VAB59717Medicare UPIN
VA1760424741Medicaid
VA006400795Medicaid