Provider Demographics
NPI:1205604394
Name:GARNETT, ANTELL
Entity type:Individual
Prefix:
First Name:ANTELL
Middle Name:
Last Name:GARNETT
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:PO BOX 11384
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-0384
Mailing Address - Country:US
Mailing Address - Phone:317-619-6655
Mailing Address - Fax:
Practice Address - Street 1:664 E 29TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-4174
Practice Address - Country:US
Practice Address - Phone:317-619-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)