Provider Demographics
NPI:1942467329
Name:GARRETT, JOHN MCCOLLUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MCCOLLUM
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 OLD SPRING HOUSE LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6225
Mailing Address - Country:US
Mailing Address - Phone:770-458-1216
Mailing Address - Fax:
Practice Address - Street 1:1776 OLD SPRING HOUSE LN
Practice Address - Street 2:SUITE 102
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6225
Practice Address - Country:US
Practice Address - Phone:770-458-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0097281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice