Basic Information
| Provider Information | |||||||||
| NPI: | 1700841103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARNER FAMILY PRACTICE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 POOLE DR | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275295207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197791440 | ||||||||
| FaxNumber: | 9196625084 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 POOLE DR | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197791440 | ||||||||
| FaxNumber: | 9196620613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | WALL | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9197790811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 40380 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89013M8 | 05 | NC | MEDICAID |