Provider Demographics
NPI:1942382429
Name:GARLAND, RICKY STEVEN (PA-C)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:STEVEN
Last Name:GARLAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0386
Mailing Address - Country:US
Mailing Address - Phone:912-754-0380
Mailing Address - Fax:912-754-1250
Practice Address - Street 1:3 HIDDEN CREEK DR
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-4590
Practice Address - Country:US
Practice Address - Phone:912-772-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004080363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01184192OtherAMERIGROUP
582203199-009OtherTRICARE AFFILIATION
GA873868589DMedicaid
GA873868589EMedicaid
SC0584PAMedicaid
GA873868589BMedicaid
GA873868589KMedicaid
GAP00477553OtherRR MEDICARE
GA873868589JMedicaid
GA873868589FMedicaid
582203199-004OtherTRICARE AFFILIATION
GA873868589FMedicaid
GA873868589EMedicaid
GA511I970265Medicare PIN