# SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1235941394
- **Legal business name:** SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
- **Authorized official:** LORI DIXON (DIRECTOR, FINANCE)
- **Authorized official phone:** (301) 533-4251

## Contact information

- **Practice address:** 922 NATIONAL HWY, LAVALE, MD 21502-7325
- **Practice address phone:** (240) 362-7294
- **Practice address fax:** (240) 362-7366
- **Mailing address:** PO BOX 1647, MORGANTOWN, WV 26507-1647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/24/2025
- **Last updated:** 01/24/2025