Provider Demographics
NPI:1083395636
Name:CASE, GARRETT (DNAP CRNA)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:CASE
Suffix:
Gender:M
Credentials:DNAP CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S BRANNON STAND RD APT C33
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7370
Mailing Address - Country:US
Mailing Address - Phone:717-965-2367
Mailing Address - Fax:
Practice Address - Street 1:1121 S BRANNON STAND RD APT C33
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7370
Practice Address - Country:US
Practice Address - Phone:717-965-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL148362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program