Healthcare Provider Details

I. General information

NPI: 1720485568
Provider Name (Legal Business Name): DANIEL ALEXANDER GARRISON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST
MIAMI FL
33136
US

IV. Provider business mailing address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6857
  • Fax: 305-243-4512
Mailing address:
  • Phone: 901-595-3471
  • Fax: 901-595-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3478
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: