Basic Information
| Provider Information | |||||||||
| NPI: | 1942382429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARLAND | ||||||||
| FirstName: | RICKY | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 386 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313290386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127540380 | ||||||||
| FaxNumber: | 9127541250 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 HIDDEN CREEK DR | ||||||||
| Address2: | |||||||||
| City: | GUYTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313124590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127728620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 004080 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 004080 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 01184192 | 01 | GA | AMERIGROUP | OTHER | 582203199-009 | 01 | TRICARE AFFILIATION | OTHER | 873868589D | 05 | GA | MEDICAID | 873868589E | 05 | GA | MEDICAID | 0584PA | 05 | SC | MEDICAID | 873868589B | 05 | GA | MEDICAID | 873868589K | 05 | GA | MEDICAID | P00477553 | 01 | GA | RR MEDICARE | OTHER | 873868589J | 05 | GA | MEDICAID | 873868589F | 05 | GA | MEDICAID | 582203199-004 | 01 | TRICARE AFFILIATION | OTHER |