Basic Information
| Provider Information | |||||||||
| NPI: | 1205194834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46844 WOODFIELD DR | ||||||||
| Address2: | |||||||||
| City: | MATTAWAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490718636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086211831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 GOODMAN ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2012 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 57.021953 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35129076 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.