Provider Demographics
NPI:1174993240
Name:GARRETT, TAMEKA L (NP-C)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:L
Last Name:GARRETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TAMEKA
Other - Middle Name:L
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6012
Practice Address - Fax:864-560-6013
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC68885019OtherMEDICARE PIN
SCGP4622Medicaid
SCNP3613Medicaid