MEDICARE: MRS. CAROLYN GARRISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2472R0900X	Renal Dialysis Technician		VA

General Provider Information

NPI Number	:	1073469169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN GARRISON

Provider Business Mailing Address
First Line	:	227 SHELTON SHOP RD
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-6504
Country	:	US
Telephone Number	:	540-322-7644
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 SHELTON SHOP RD
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-6504
Country	:	US
Telephone Number	:	540-628-4257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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