Provider Demographics
NPI:1881153161
Name:GARRETT, KRISTY KAY (BS)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:KAY
Last Name:GARRETT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 FAIRBURN RD STE A
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1037
Mailing Address - Country:US
Mailing Address - Phone:770-726-7958
Mailing Address - Fax:770-693-0829
Practice Address - Street 1:2109 FAIRBURN RD STE A
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1037
Practice Address - Country:US
Practice Address - Phone:770-726-7958
Practice Address - Fax:770-693-0829
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1730482621OtherNPI