1043042260 NPI number — MERCEDES IMANI GARNER

Table of content: MERCEDES IMANI GARNER (NPI 1043042260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043042260 NPI number — MERCEDES IMANI GARNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARNER
Provider First Name:
MERCEDES
Provider Middle Name:
IMANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATTERSON
Provider Other First Name:
MERCEDES
Provider Other Middle Name:
IMANI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043042260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 MEADOW OAK DR APT 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27406-8288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-338-6668
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 NATIONAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27360-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-472-8230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)