Provider Demographics
NPI:1043474091
Name:GARRETT, NAIMA (MD)
Entity type:Individual
Prefix:DR
First Name:NAIMA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAIMA
Other - Middle Name:
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1759 BROAD PARK CIR S STE 201
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7834
Mailing Address - Country:US
Mailing Address - Phone:682-341-3910
Mailing Address - Fax:
Practice Address - Street 1:1759 BROAD PARK CIR S STE 201
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7834
Practice Address - Country:US
Practice Address - Phone:682-341-3910
Practice Address - Fax:682-400-1288
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0915208000000X, 208000000X, 208D00000X
HI15697208000000X
TXJ9741208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN