Healthcare Provider Details

I. General information

NPI: 1316253735
Provider Name (Legal Business Name): COURTNEY STEVENS- GARRISON C.PED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W ROOSEVELT BLVD SUITE A
MONROE NC
28110-3762
US

IV. Provider business mailing address

1900 W ROOSEVELT BLVD SUITE A
MONROE NC
28110-3762
US

V. Phone/Fax

Practice location:
  • Phone: 704-225-0285
  • Fax: 704-225-0287
Mailing address:
  • Phone: 704-225-0285
  • Fax: 704-225-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberCPED3196
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: