Provider Demographics
NPI:1053322750
Name:GARRARD & WOODSIDE LLC
Entity type:Organization
Organization Name:GARRARD & WOODSIDE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:GARRARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-424-6203
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-9742
Mailing Address - Country:US
Mailing Address - Phone:901-465-6755
Mailing Address - Fax:901-465-1769
Practice Address - Street 1:201 LAKEVIEW DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-9742
Practice Address - Country:US
Practice Address - Phone:901-465-6755
Practice Address - Fax:901-465-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN619332B00000X, 332BX2000X
TN4579734333600000X
TN28875333600000X
TNID1430333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN118365OtherUNISON
TN118365OtherUNISON TN CARE
TN1452509Medicaid
20164OtherMPHS MG CARE TN CARE
1295050001Medicare ID - Type Unspecified