Provider Demographics
NPI:1649376765
Name:GARRETT, WILLIAM ALLAN JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLAN
Last Name:GARRETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:365 STOUT DRIVE
Mailing Address - Street 2:BOX 70403
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4515
Mailing Address - Fax:423-439-5780
Practice Address - Street 1:1500 W ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643
Practice Address - Country:US
Practice Address - Phone:423-543-2584
Practice Address - Fax:423-722-2060
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN37657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509059Medicaid