Provider Demographics
NPI:1992865794
Name:GARNETT, TOMMY W (DPM)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:W
Last Name:GARNETT
Suffix:
Gender:M
Credentials:DPM
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 242848
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2848
Mailing Address - Country:US
Mailing Address - Phone:334-270-9914
Mailing Address - Fax:
Practice Address - Street 1:74186 TALLASSEE HIGHWAY
Practice Address - Street 2:STE A
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-5644
Practice Address - Country:US
Practice Address - Phone:334-514-6922
Practice Address - Fax:334-514-6068
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL162213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51031221OtherBLUE CROSS
AL051031221Medicare ID - Type Unspecified
ALU61690Medicare UPIN
AL1146240001Medicare NSC