Provider Demographics
NPI:1912054222
Name:GARRETT, LESLIE WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:WAYNE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-0752
Mailing Address - Country:US
Mailing Address - Phone:386-325-3815
Mailing Address - Fax:
Practice Address - Street 1:101 RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-4353
Practice Address - Country:US
Practice Address - Phone:386-325-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30625207U00000X, 2085U0001X, 2085N0904X, 2085R0202X
ND9935207U00000X, 2085N0904X, 2085R0202X, 2085U0001X
WAMD00042982207U00000X, 2085N0904X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology