Provider Demographics
NPI:1649248444
Name:GARVIN, TARSHA V (MD)
Entity type:Individual
Prefix:
First Name:TARSHA
Middle Name:V
Last Name:GARVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 OLD WINSTON RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9964
Mailing Address - Country:US
Mailing Address - Phone:336-993-4502
Mailing Address - Fax:336-993-7196
Practice Address - Street 1:900 OLD WINSTON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9964
Practice Address - Country:US
Practice Address - Phone:336-993-4502
Practice Address - Fax:336-993-7196
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00043208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950096Medicaid
NC5950096Medicaid
NC2037439BMedicare PIN