Provider Demographics
NPI:1639901838
Name:GARLAND, SIMONE M
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:M
Last Name:GARLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 LOIS ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3636
Mailing Address - Country:US
Mailing Address - Phone:517-505-0977
Mailing Address - Fax:
Practice Address - Street 1:8801 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2136
Practice Address - Country:US
Practice Address - Phone:517-505-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker