Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 31140 | KY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 31140 | KY |
NPI | 1710088877 |
---|---|
Provider Name | John K Garner |
First Address | Campbellsville, KY 42718-9663 |
Second Address | Campbellsville, KY 42718-9663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F9570 | (02) | KY |