Provider Demographics
NPI:1528052784
Name:GARRETT, GEORGE C JR (MD)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:C
Last Name:GARRETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BILL CLINTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8661
Mailing Address - Country:US
Mailing Address - Phone:870-777-0700
Mailing Address - Fax:870-722-5604
Practice Address - Street 1:302 BILL CLINTON DR
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8607
Practice Address - Country:US
Practice Address - Phone:870-777-0700
Practice Address - Fax:870-722-5604
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4987207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102606001Medicaid
AR51836F484Medicare PIN
AR518367470Medicare PIN
ARC68330Medicare UPIN
AR51836F528Medicare PIN