Provider Demographics
NPI:1740487867
Name:GARRETT, JACKIE (MD)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46 DAGGETT DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4646
Mailing Address - Country:US
Mailing Address - Phone:413-707-7720
Mailing Address - Fax:413-707-7730
Practice Address - Street 1:46 DAGGETT DR STE 1A
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4646
Practice Address - Country:US
Practice Address - Phone:413-707-7720
Practice Address - Fax:413-707-7730
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA255915207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology