MEDICARE: DR. CLIFTON GARRIS M.D.

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	207Q00000X	Family Medicine Physician	26623	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51109879	OTHER	AL	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629092515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFTON GARRIS M.D.

Provider Business Mailing Address
First Line	:	1023 WEST FORT WILLIAMS ST
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2432
Country	:	US
Telephone Number	:	256-245-6700
Fax Number	:	256-245-6002

Provider Business Practice Location Address
First Line	:	1023 WEST FORT WILLIAMS ST
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2432
Country	:	US
Telephone Number	:	256-245-6700
Fax Number	:	256-245-6002

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/26/2011

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