Individual
GARRICK LAMONT MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QBHS
Contact information
Practice address
209 W WOODLAND AVE, YOUNGSTOWN, OH 44502-1866
(330) 787-9180
Mailing address
594 QUARRY LN NE, WARREN, OH 44483-4535
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
812009857
—
OH
Enumeration date
05/16/2018
Last updated
05/16/2018
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