1306970850 NPI number — MYLAH DELAINE GARLINGTON PT, MPT

Table of content: MYLAH DELAINE GARLINGTON PT, MPT (NPI 1306970850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306970850 NPI number — MYLAH DELAINE GARLINGTON PT, MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARLINGTON
Provider First Name:
MYLAH
Provider Middle Name:
DELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306970850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6397 LEE HWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-4915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-238-7212
Provider Business Mailing Address Fax Number:
423-238-3473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5370 CAMPBELLTON FAIRBURN RD STE 530
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30213-2296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-666-4146
Provider Business Practice Location Address Fax Number:
678-666-4148
Provider Enumeration Date:
03/15/2007

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: 225100000X , with the licence number:  22099 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT014030 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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