Provider Demographics
NPI:1104908409
Name:GARRIETT-LAMPKIN, VICTORIA (MD, MPH)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GARRIETT-LAMPKIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 LATTA SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2333
Mailing Address - Country:US
Mailing Address - Phone:704-737-7071
Mailing Address - Fax:
Practice Address - Street 1:6055 LATTA SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2333
Practice Address - Country:US
Practice Address - Phone:704-737-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25811208000000X
NC2006-01640208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104908409Medicaid
MD699504700Medicaid
DC028241700Medicaid
VA5865093Medicaid