Provider Demographics
NPI:1497572531
Name:BROWN, GARRETT NOLAN
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:NOLAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LAKEVIEW ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-8206
Mailing Address - Country:US
Mailing Address - Phone:706-816-0708
Mailing Address - Fax:
Practice Address - Street 1:6350 LAKE OCONEE PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-6433
Practice Address - Country:US
Practice Address - Phone:706-454-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist