Provider Demographics
NPI:1871941948
Name:GARRETT, LAJUANA
Entity type:Individual
Prefix:
First Name:LAJUANA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 FRAYSER DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-1413
Mailing Address - Country:US
Mailing Address - Phone:901-491-0088
Mailing Address - Fax:901-800-1829
Practice Address - Street 1:793 FRAYSER DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-1413
Practice Address - Country:US
Practice Address - Phone:901-491-0088
Practice Address - Fax:901-800-1829
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374U00000X
TN1000000018261253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1013365030Medicaid