Provider Demographics
NPI:1881484228
Name:DOUGLAS, GARRETT STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:STEPHEN
Last Name:DOUGLAS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W HIGH ST APT 211
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2585
Mailing Address - Country:US
Mailing Address - Phone:561-702-5270
Mailing Address - Fax:
Practice Address - Street 1:2148 N 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1304
Practice Address - Country:US
Practice Address - Phone:856-641-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program