Provider Demographics
NPI:1205896339
Name:GARNER, STEPHEN LEWIS (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:GARNER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 WALNUT FOREST DRIVE
Mailing Address - Street 2:APT. M
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5654
Mailing Address - Country:US
Mailing Address - Phone:704-779-1528
Mailing Address - Fax:
Practice Address - Street 1:740 WALNUT FOREST DRIVE
Practice Address - Street 2:APT. M
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5654
Practice Address - Country:US
Practice Address - Phone:704-779-1528
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer