1649671900 NPI number — ELIZABETH SKARDON GARRISON MSP

Table of content: ELIZABETH SKARDON GARRISON MSP (NPI 1649671900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649671900 NPI number — ELIZABETH SKARDON GARRISON MSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARRISON
Provider First Name:
ELIZABETH
Provider Middle Name:
SKARDON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649671900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29071-0708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-359-3195
Provider Business Mailing Address Fax Number:
803-520-8398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5175 SUNSET BLVD
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29072-7319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-359-3195
Provider Business Practice Location Address Fax Number:
803-520-8398
Provider Enumeration Date:
09/05/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  5573 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)