Healthcare Provider Details

I. General information

NPI: 1467468470
Provider Name (Legal Business Name): COY L GARRICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/19/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 PICKENS ST
COLUMBIA SC
29201
US

IV. Provider business mailing address

100 PALMETTO PARK BLVD
LEXINGTON SC
29072
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-7732
  • Fax: 803-748-7199
Mailing address:
  • Phone: 803-806-0075
  • Fax: 803-356-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number00015427
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: