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Individual

GARRETT DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1240 BROAD AVE STE B, GULFPORT, MS 39501-2416
(601) 456-5100
Mailing address
37 GOOD HOPE RD, COLUMBIA, MS 39429-8914

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
882599
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
007953363
MS
Enumeration date
06/02/2015
Last updated
07/29/2024
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