Provider Demographics
NPI:1912729278
Name:GARRARD, JERRY EMAMURHO
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:EMAMURHO
Last Name:GARRARD
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 1:7219 PARK HEIGHTS AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5462
Mailing Address - Country:US
Mailing Address - Phone:571-409-9849
Mailing Address - Fax:
Practice Address - Street 1:7219 PARK HEIGHTS AVE APT 305
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5462
Practice Address - Country:US
Practice Address - Phone:571-409-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker