Provider Demographics
NPI:1770711608
Name:GARRETT, GEORGE N (HIS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:N
Last Name:GARRETT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 HIGHWAY 49 STE 314
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3178
Mailing Address - Country:US
Mailing Address - Phone:228-539-5400
Mailing Address - Fax:228-832-1590
Practice Address - Street 1:12100 HIGHWAY 49 STE 314
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3178
Practice Address - Country:US
Practice Address - Phone:228-539-5400
Practice Address - Fax:228-832-1590
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0543237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist