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General NPI Number Information
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NPI Number | 1619170396
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Entity Type | Individual
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Provider Name | HAZEL GRAY GARRISH MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 2406 BLUE RIDGE RD SUITE 100
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City | RALEIGH
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State | NC
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Zip | 27607-6678
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Country | US
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Telephone | 919-786-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 2406 BLUE RIDGE RD SUITE 100
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City | RALEIGH
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State | NC
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Zip | 27607-6678
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Country | US
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Telephone | 919-786-5001
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116019216
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2010-00558
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License Number State | NC
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