Provider Demographics
NPI:1750439212
Name:J. TIMOTHY GARNER, MD, PLLC
Entity type:Organization
Organization Name:J. TIMOTHY GARNER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-0340
Mailing Address - Street 1:1205 MONTGOMERY AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2669
Mailing Address - Country:US
Mailing Address - Phone:606-324-0340
Mailing Address - Fax:606-324-0044
Practice Address - Street 1:1205 MONTGOMERY AVE STE 4
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3518
Practice Address - Country:US
Practice Address - Phone:606-324-0340
Practice Address - Fax:606-324-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008408363LF0000X
KY33507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00141Medicare PIN
G21806Medicare UPIN