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General NPI Number Information
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NPI Number | 1558132514
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Entity Type | Individual
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Provider Name | MERCEDES CHANTAL GARRISON
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Gender | Female
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 211 E LEWIS ST STE A
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City | GREENSBORO
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State | NC
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Zip | 27406-1552
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Country | US
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Telephone | 336-693-0905
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 CAROL AVE
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City | GREENSBORO
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State | NC
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Zip | 27406-9208
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Country | US
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Telephone | 336-693-0905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C83665
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License Number State | NC
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