Provider Demographics
NPI:1073854956
Name:GARRISON, ALLYSON HARRELL (PA)
Entity Type:Individual
Prefix:MISS
First Name:ALLYSON
Middle Name:HARRELL
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-216-3530
Mailing Address - Fax:877-896-6449
Practice Address - Street 1:912 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-216-3530
Practice Address - Fax:877-896-6449
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-02
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1862363A00000X, 363AM0700X
NC0010-03938363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3667PAMedicaid