Provider Demographics
NPI:1992142574
Name:GARRETT, CHARLOTTE ANN
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ANN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:ANN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2744
Mailing Address - Street 2:115 PONDEROSA TRAIL
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301
Mailing Address - Country:US
Mailing Address - Phone:936-777-0286
Mailing Address - Fax:936-242-6556
Practice Address - Street 1:115 PONDEROSA TRAIL
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301
Practice Address - Country:US
Practice Address - Phone:936-777-0286
Practice Address - Fax:936-242-6556
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies