Provider Demographics
NPI:1356983225
Name:GARNER, RICKY RICARDO
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:RICARDO
Last Name:GARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 LOWER RICHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-8631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1613 LOWER RICHLAND BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-8631
Practice Address - Country:US
Practice Address - Phone:865-256-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No372600000XNursing Service Related ProvidersAdult Companion