Healthcare Provider Details

I. General information

NPI: 1912681347
Provider Name (Legal Business Name): GEORGIA GARRISON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

8422 US HIGHWAY 158
STOKESDALE NC
27357
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-4400
  • Fax: 336-832-4440
Mailing address:
  • Phone: 336-560-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5018201
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5018201
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: