Provider Demographics
NPI:1912511064
Name:GARRETT, DOUGLAS TRUMAN JR (NP)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:TRUMAN
Last Name:GARRETT
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-4208
Mailing Address - Country:US
Mailing Address - Phone:803-645-3198
Mailing Address - Fax:
Practice Address - Street 1:6416 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:APPLING
Practice Address - State:GA
Practice Address - Zip Code:30802-4208
Practice Address - Country:US
Practice Address - Phone:803-645-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner