Provider Demographics
NPI:1831413426
Name:JOE GARMON
Entity type:Organization
Organization Name:JOE GARMON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:229-226-0741
Mailing Address - Street 1:200 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6640
Mailing Address - Country:US
Mailing Address - Phone:229-226-0741
Mailing Address - Fax:229-227-9360
Practice Address - Street 1:200 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6640
Practice Address - Country:US
Practice Address - Phone:229-226-0741
Practice Address - Fax:229-227-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0023531041C0700X
GAPSY002910103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA160744945AMedicaid
GA160744945AMedicaid
GAQ28242Medicare UPIN