Provider Demographics
NPI:1285490516
Name:GAMBILL, GARRETT
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:GAMBILL
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 1:664 TOTTY CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3071
Mailing Address - Country:US
Mailing Address - Phone:901-496-6905
Mailing Address - Fax:
Practice Address - Street 1:664 TOTTY CV
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3071
Practice Address - Country:US
Practice Address - Phone:901-496-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical