Provider Demographics
NPI:1427070739
Name:GARRETT, DONALD (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CARRIAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6276
Mailing Address - Country:US
Mailing Address - Phone:770-331-7134
Mailing Address - Fax:
Practice Address - Street 1:225 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 140
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7300
Practice Address - Country:US
Practice Address - Phone:678-565-0400
Practice Address - Fax:678-565-0444
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC2713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA510631680AMedicaid