MEDICARE: KALENE 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1295519858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALENE GARRISON

Provider Business Mailing Address
First Line	:	1109 VILLA POINT PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-9227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 VILLA POINT PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-9227
Country	:	US
Telephone Number	:	302-344-2444
Fax Number	:

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

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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Directions to “ KALENE GARRISON ” Practice Location

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