Provider Demographics
NPI:1982664256
Name:GARROTT, THOMAS CALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CALVIN
Last Name:GARROTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MARKS ROAD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-872-8873
Mailing Address - Fax:228-872-8876
Practice Address - Street 1:24 MARKS ROAD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-872-8873
Practice Address - Fax:228-872-8876
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5435207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014426Medicaid
MS00014426Medicaid
MS071920061Medicare ID - Type Unspecified