Provider Demographics
NPI:1952094799
Name:GARNER, ANDREA CARROLL
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CARROLL
Last Name:GARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-4421
Mailing Address - Country:US
Mailing Address - Phone:910-795-6673
Mailing Address - Fax:
Practice Address - Street 1:6049 SHILOH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-4421
Practice Address - Country:US
Practice Address - Phone:910-795-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program