Provider Demographics
NPI:1306878756
Name:GARLAND, JEFFREY SCOTT
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:GARLAND
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 1:5261 CARROLLTON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3034
Mailing Address - Country:US
Mailing Address - Phone:276-238-0911
Mailing Address - Fax:276-238-0912
Practice Address - Street 1:5261 CARROLLTON PIKE STE C
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3034
Practice Address - Country:US
Practice Address - Phone:276-238-0911
Practice Address - Fax:276-238-0912
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45543207R00000X
VA0101241040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306878756Medicaid
P00977738OtherPTAN
WI34388400Medicaid
C10361OtherGROUP PTAN
261083931OtherTAX ID
MN070997200Medicaid
DN2980OtherGROUP PTAN
DN2980OtherGROUP PTAN
P00977738OtherPTAN