Provider Demographics
NPI:1770594079
Name:GARRETT, JOHN G (APRN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:GARRETT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N JAMES M CAMPBELL BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2758
Mailing Address - Country:US
Mailing Address - Phone:931-548-8657
Mailing Address - Fax:931-548-8658
Practice Address - Street 1:1040 N JAMES M CAMPBELL BLVD STE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2758
Practice Address - Country:US
Practice Address - Phone:931-548-8657
Practice Address - Fax:931-548-8658
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6925208VP0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MG0948832OtherDEA
P87571Medicare UPIN