Provider Demographics
NPI:1750369898
Name:GARRETT, LELAND E JR (MD)
Entity type:Individual
Prefix:DR
First Name:LELAND
Middle Name:E
Last Name:GARRETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 RAIN FORREST WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8664
Mailing Address - Country:US
Mailing Address - Phone:919-630-6355
Mailing Address - Fax:919-846-6124
Practice Address - Street 1:3230 RAIN FORREST WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8664
Practice Address - Country:US
Practice Address - Phone:919-630-6355
Practice Address - Fax:919-846-6124
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934696Medicaid
NC34696OtherBCBS PROVIDER NUMBER
NC8934696Medicaid
NC2158714Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER