Provider Demographics
NPI:1699096172
Name:GARRETT, WANDA P (BSW,MS)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:P
Last Name:GARRETT
Suffix:
Gender:F
Credentials:BSW,MS
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 17534
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-0534
Mailing Address - Country:US
Mailing Address - Phone:404-455-2907
Mailing Address - Fax:404-286-5683
Practice Address - Street 1:3013 RAINBOW DRIVE, SUITE 112-E
Practice Address - Street 2:SOUTH DEKALB OFFICE PARK
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034
Practice Address - Country:US
Practice Address - Phone:404-455-2907
Practice Address - Fax:404-286-5683
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker